ORDER REQUEST FORM Omnilux Contour™ Use this form to place your order request. Upon receipt one of our representatives will contact you to arrange payment and finalize your order. Due to the impact of COVID-19 and increased order volumes, orders may be delayed. Please Note: Omnilux Contour is currently only available for delivery in the United States. lf you are interested in the product in another country please complete the Contact Sales Form or call GlobalMed Technologies at: US Skin Professional Sales: +1 (760) 827-5380 Consumer and All Other Sales: +1 (707) 224-0200 Business hours are M-F 9:00 a.m. to 5:00 p.m. PST *Required Field Your DetailsI am a:*Professional Skin Care ProviderPhysicianConsumerConsumer Instructions If you are a consumer please follow this link and place your order on our consumer website: OmniluxLEDcomName* First Last Email* Enter Email Confirm Email Phone*Your OrderOmnilux Contour FACE Quantity* Price: $395.00 Quantity Omnilux Contour NECK & DECOLLETE Quantity Price: $395.00 Quantity Omnilux Contour GLOVE Quantity Price: $345.00 Quantity Omnilux Contour Hydrogel Mask Quantity Price: $29.00 Quantity Complements Contour FACE. Comes in packs of three.Total $0.00 Includes free shipping in the 48 contiguous US States. Orders in California are subject to State TaxShipping Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
