Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: info@s-e-a

Your Order

Order Options

  • Place your order by phone (877-730-2727)

  • Complete this form and click send ( info@s-e-a.net )

  • Complete this form, print, and Fax (618-236-2826)

  • Complete this form, print, and mail to:

  • Lice B Gone 
    P.O. Box 528
    Belleville, IL 62222-0528

    Payment Options

  • Credit Card (complete info below)
  • Check or Money Order (mail orders only)
  • Purchase Order #
  • Ordered by:

    Name:              
    Street Address:  
    City: State: Zip:

    Phone: Email:  
    Fax:    

    Contact Name & Title

    Ship to: (if different)

    Name:              
    Street Address:
    City: State: Zip:

    Phone: Email:  
    Fax:    

    Attention:

    Description Quantity  Price/each  Amount

    Personal
    4 fl oz, up to 2 treatments

      $7.00

     $

    Personal Size Kit
    Includes nit comb & two shower caps

      $10.00

     $

    Family Size
    16 oz, up to 8 treatments

      $16.00

     $
    Institutional Size
    128 oz (gal), up to 64 treatments
      $64.00

     $

    Shipping & Handling

       

    $ 5.00

    Michigan Sales Tax
     
    (6%, if applicable)

       

     $

    Total
     

     $

    Credit Card Info

    Visa MasterCard
    Card Number:
    Expiration Date: 00/00
    /
    Name Appearing on Card:


    © 1999-2000 Safe Effective Alternatives, Inc.

    Belleville, Illinois