Special Compounding Form
CUSTOMER NAME: DATE
LANDLINE No. MOBILE No. E-MAIL


ITEMS FOR COMPOUNDING USES EFFECT
OTHER INSTRUCTIONS: PLEASE SPECIFY (label, sticker etc)

I hereby certify that the above information are correct and stated according to my request and further understand the terms and conditions stated below the product information.

Please deposit your payment at these bank accounts:

BANCO DE ORO Mayon Branch
Account number: SA#1-05801001-7
Account name: Shady Cosmetique Laboratory

ASIA UNITED BANK Del Monte Branch
Account number: 008010002973
Account name: Shady Cosmetique Laboratory