The Safe Alternative to Smoking

 

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 STEP 1      CUSTOMER INFORMATION          

Customer Information Ship to:  only complete if the shipping address is different
                         from Customer Information
   
First Name
Last Name
Billing Address 1
Billing Address 2
City


Postal/Zip Code
Phone Number
Email 		First Name
Last Name
Shipping Address 1
Shipping Address 2
City


Postal/Zip Code

Email
       
 STEP 2      PRODUCT ORDER             
   
 
DESCRIPTION QTY PRICE
Ciganot Stop Smoking Program $ 39.99
Ciganot Smokeless Cigarette $ 9.99 ea
CigArręte Mini-Filters $ 2.99/pkg
   
 STEP 3       PAYMENT METHOD
 
 
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