Order by Mail or Fax

To order by mail: Complete the requested information, print this form, and mail it along with your check, money order, or certified bank draft to:
Dr. R. Williams
12430 Tesson Ferry Road Ste#312
St. Louis, MO 63128
USA

To order by fax: Complete the requested information -- including your credit card information -- print the form, and fax it to: (314) 842-6065

*If ordering from outside the U.S., you must pay with a certified bank draft, international money order, or credit card.

NOTE: We will not process your order UNLESS you list the security code from your card. This code is printed on either the front of the card, or the back of the card

Select the desired option below:

When a Man Makes love to a woman (on-line download) - $39.99

ABC's of Penis enlargement Naturally Online Manual Only - $49.99

     Testosterone Test kit - $79.99 (+$10 s/h)

Penis Enlargement Online Manual + Test kit - $119.99 (+$10 s/h)

   Penis Enlargement manual/Test kit/When a Man... - $125.99(+ $10 s/h)

All orders must include a valid e-mail address.

E-Mail Address:

 
Credit Card Orders Only: Complete the following and sign below.

Cardholder Name:

Billing Address:

City:

State:

Zip/Postal Code:

Telephone:

Credit Card Type:

Visa    MasterCard    Discover    American Express

Credit Card Number:

Expiration Date:

Credit card security # (located on front or back - ALL DIGITS)

 
I hereby authorize Dr. Williams to charge my credit card as indicated for access to his online service.

Signature:

 

Type or Print Name:

Date:

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