For Canadian residents only
Please complete the order form below:
* required fields
*Gender:
Ms.
Mr.
*First name:
*Last name:
*Practice or institution name:
*Address:
*City:
*Province:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
*Postal code:
*Phone:
Fax:
E-mail:
*Permit #:
*Reason for request:
Samples for patients
Special event
*Product and Quantity requested (for each)
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2
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9
10
Face SPF 45
x 6-ml samples – Box of 36
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2
3
4
5
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7
8
9
10
Kids SPF 60
x 6-ml samples – Box of 36
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2
3
4
5
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7
8
9
10
Gel SPF 30
x 6-ml samples – Box of 36
Please note that all orders will be processed and shipped within 5 business days of receipt.
Allow 3 weeks delay for shipping.
* Source : Survey among Canadian dermatologists by IFOP/Canada market research in February 2008, mandated by L’Oréal Canada.