SALE
All Devices Discounted
25%

 

 

 
Order Form

This form can either be sent via the net (by pressing the "Submit This Form" button below), or printed and mailed to us. Just follow directions below.1 - 6

If you have any questions, please call us at 1-732-657-4401 between 9 a.m. and 5 p.m. EST.

This order form is SECURE.

Pricing for the Circle Device is as follows:

  • 12 oz - $100.00 ($US); SALE PRICE = $75.00
  • 16 oz - $135.00 ($US); SALE PRICE = $101.25
  • 24 oz - $225.00 ($US); SALE PRICE = $168.75
  • 32 oz - $300.00 ($US); SALE PRICE = $225.00

Each order contains:

  • 1 Device (sealed in a plastic bag)
  • A velvet string pouch to store your Device
  • Full, simple instructions
  • 5 elastic bands
  • Instructions on exercises that will increase hardness and girth of the erect penis

All orders are shipped within 24 hours of receipt of payment, in a discrete package, via first class mail.

We accept a certified bank check or money order (no personal checks), or one of the following credit cards:

1) Determine sizing and fill in the chart below. If you need a tapered device, please put the two measurements requested in the second column below.

Tapered devices cost an addtional $20.00 for the 12oz or 16oz, $40 for the 24oz and 32oz and if they are over 5" in circumference, there will be an additonal $75.00 charge.
Yes, I will pay extra for a tapered device

Qty Circumference
of flaccid (soft) penis; 3" minimum		 Device

Notes:

  • Any device can vary up to 15 grams in weight, due to customizing.
  • Any device over 5.0 inches in circumference will cost an additional $75.00
  • Any device returned for adjustment requiring more than 1/8" adjustment will cost $25.00 plus shipping (see shipping charges below).

2) Fill in the form:

First Name :
Last Name :
Shipping Address :
City :
State/Prov. :
Zip Code :
Country :
Telephone Home*:
Telephone Work*:
Fax*:
E-Mail :
Credit Card Billing address, if different than the shipping address:

* For international numbers, please include country code.

3) Select your payment type:

Payment Type:

Remember: if paying by credit card, please fill in your billing address above.

All monies are in US$.

All orders within the U.S.A. are shipped U.S.P.S. Priority Mail, Confirmation Delivery. Upon credit card approval, you should receive your order within 5 days within the U.S.A. All outside of the U.S.A. shipments are made via Express Mail, which should be within 8 days.

Shipping charges within the United States are $5 or the 12 oz and 16 oz Circle Device and $10 for the 24 oz and 32 oz Circle Devices. Shipping charges for outside the USA are all $25, regardless of weight.

For shipment outside the US, orders must be paid by credit card as this eliminates money differences between foreign countries and collection of monies that can hold up shipment of our product.

NJ residence must pay a 7% sales tax.
Credit Card Type:
 Card Number:
 Exp. Date:
Security Code (3 digits on back of card). Required field:
Card Holder's Name:
 Card Holder's Signature (use when faxing or mailing form):

4) Please fill in some marketing information:

Where Did You Hear of Us?:

Please elaborate (e.g.: which magazine did you see our ad in; if searching on the Net, what Search Engine and keyword did you use; etc.):
 Comments or Questions:

5) Fill in the totals: Note: all monies are in US Dollars

Device(s) Cost:

12 oz: $75.00
16 oz: $101.25
24 oz: $168.75
32 oz: $225.00
Tapering Cost 12oz: $20.00
16oz: $20.00
24oz: $40.00
32oz: $40.00
Shipping Charge for EACH device:
Within USA:
12oz: $5.00
16oz: $5.00
24oz: $10.00
32oz: $10.00

Outside USA:
$25.00
NJ Res. only Sales Tax (7%):
12oz: $5.25
16oz: $7.08
24oz: $11.81
32oz: $15.75
TOTAL PAYMENT:
 US$

6) Please choose one of the next three options:

  • For credit card orders you may Order on-line. Press...
  • to start over, press...
  • For any payment type, print this form from your browser and then mail it to us with either your certified check, money order, or credit card information:
    D. France, Inc.
    PO Box 293
    Lakehurst, NJ 08733 USA

THANK YOU

Due to the nature of the Circle Device,
IT IS NOT RETURNABLE.

A charge of $10.00 will be charged
for shipping and handling for any adjustment work

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How to Use || Order || Links

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ORDER Today!

International and US customers welcome!

Please send us any questions or suggestions you may have -- they are always welcome. All inquiries are kept confidential.

For free printed information: you can either print these pages using your browser's print command or send a self-addressed stamped envelope to us.

1998-2010 (c) D. France, Inc.
All rights reserved.

The Circle Device is patented; any infringement of its design and intended use will be prosecuted by law.

Last updated 5/23/09