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ZENMED   Fax & Mail Order Form | | Toll Free: 1.888.749.4998 | Fax: 1.250.800.2703
Billing Information   Shipping Information (if different)
Name: Name:
Address: Address:
City: City:
State/Province: State/Province:
Country: Country:
ZIP/Postal Code: ZIP/Postal Code:
Email address is required for order confirmation and order tracking. We do not sell email addresses.
Payment Options
    Amex     Mastercard     Visa     Check     Money Order
International Money Orders only. Payable to ‘Raging Creations Ltd.’
Credit Card Details
Card Number:
Expiry Date:
I authorize ZENMED®/ Raging Creations Ltd. to debit my card for the value of my order.
Signature   Date
Order online at
By Mail
Complete this order form and mail it with your payment enclosed to:
     c/o Customer Service
     #45 - 747 Princess Avenue
     Victoria, BC Canada
     V8T 1K5
By Fax
Fax your completed order form to:
     Fax: 1.250.800.2703
By Phone
Call one of our friendly customer service representatives 24 hours a day 7 days a week if you have any questions or concerns, or if you would like to place an order.
     Phone: 1.250.800.2723
     Toll Free: 1.888.749.4998
     Freephone: 0.800.8830451
Returns and Exchanges
If for any reason you are unhappy with your products, contact us within 60 days of purchase for return instructions.

Buy 3 Get 1 FREE!
Purchase 3 bottles of any one product and receive a 4th bottle at no extra charge. Just enter a quantity of 3 on the order form and your free 4th bottle will automatically be added when your order is processed. Products marked with a ‘ * ’ are excluded from the “Buy 3 Get 1 FREE” promotion.
† The price for 2 Derma Cleanse® Systems is $124.97 and 4 Derma Cleanse® Systems is $239.91.
Acne Price QTY Total
Facial Cleansing Gel 6 fl oz/180 ml $15    
Derma Cleanse® Acne Gel 2 fl oz/60 ml $24.99    
Derma Cleanse® Capsules 90 Capsules $29.99    
AHA/BHA Complex 2.7 fl oz/80 ml    
Derma Cleanse® System * † $79.97    

Body Acne
Botanical Acne Mask 4 fl oz/120 ml *    
Botanical Acne Body Wash 8 fl oz/236.6 ml * $24.95    
Body Acne Combo *    

Skin Care
AVT Cream 2.5 fl oz/70 ml $34.95    
Oil Free Moisturizer 1 fl oz/30 ml $124.97    
Oil Free Moisturizer with SPF 30 1 fl oz/30 ml    
Three Step Skin Care System $59.99    
Oil-Free Day Lotion 2.5 fl oz/70 ml $24.95    

Skin Eraser 2 fl oz/60 ml * $29.99    
Renewing MicroDermabrasion 4 fl oz/120 ml * $39.99    
Skin Eraser Kit * $59.99    

Eczema Dermatitis
DermCare 2 fl oz/60 ml $24.95    
DermCare Cleanser 6 fl oz/180 ml $24.95    
DermCare Lotion 4 fl oz/120 ml $29.95    
DermCare System    
Rosacea Price QTY Total
Gentle Cleansing Cream 4 fl oz/120 ml $19    
Rosacea Support Serum 1.7 fl oz/50 ml $29.95    
Anti-Redness Mask 2 fl oz/60 ml $29.95    
Nutrient Boost Spray 1.7 fl oz/50 ml *    
Skin Support Supplement 90 Capsules $24.95    
Skin Support System Dry Skin * $64.95    
Skin Support System Oily Skin * $59.95    

Body Care
ZIRO 2.5 fl oz/75 ml $34.95    
Ensa 90 Capsules $24.95    
Stretta 1.7 fl oz/50 ml $49.99    

Cold Sores
AvaCare 90 Capsules $29.99    
Zenhance 90 Capsules $29.99    
AvaCare System $49.95    
Discount Code Amount
  Do you have a discount code?    
Subtotal Amount
  Subtotal before shipping  
Shipping US CAN INT'L
  Standard Ground Shipping $6.95 $12 $19
  Please allow 4-7 business days for delivery.
  The Derma Cleanse® System includes free shipping within North America
Order Total Amount
  Total including shipping.  
US : USD : 2014-09-18 04:42:51Reference Number: