Offline Order Form

Order Offline

If you are paying by check, mail you payment to the address below.

If you want to pay by credit card and are not using our online shopping cart, print this page and fax the order form to (214) 722-1935 or mail the order form to the address below.

Gay Riley, Lipo-Visuals, Inc.
1510 Braeburn Drive
Richardson, TX 75082

  • Check or PO Payment Information

    If you are paying by check or PO, enter the check or PO in the box below. When you have finished filling out the order form click send order at the bottom of this page.

  • Credit Card Payment Information

    If you are paying by credit card, and do not want to use our online shopping cart, fill in your credit card information below. When you have completed your order do not click send order. Instead, PRINT THIS PAGE, and fax it to (214) 722-1935.

  • If you are paying by credit card, you may want to use our online shopping cart. If you want to fax or mail your order, print this page after you have finished filling out this form. DO NOT click send order, if you are using a credit card.

  • Contact and Information

  • Shipping Address

  • Order Information

    Enter the number of items you wish to purchase and select the number of products you are ordering in the Shipping drop-down below. Shipping is free for orders over $200.00. Your total will automatically be calculated.

    If you are paying by check or purchase order, click the Send Order button at the bottom of the page.

    If you are paying by credit card and do not wish to use our online shopping cart, print this page and fax it to (214) 722-1935.

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  • $12.00 UPS ground track shipping for each Lipo-Visuals or Sugar-Visuals order less than $200.

    Orders over $200 include free shipping.

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