Antiqua Prima Consumer information

For Consumers...

Client Consultation Form -- click and print, fill the form out then fax to 843-236-1191 for a referral an Antiqua Prima Professional in your area.

I have read and agree to the conditions above. I acknowledge that if I complete the Client Consultation Form and fax it to Antiqua Prima (843-236-1191), it may include personal and medical health history information, and that this Consultation Form will be forwarded to an Antiqua Prima Authorized Distributor in my area. I also acknowledge that by checking "I AGREE", I give permission for the nearest Antiqua Prima Authorized Distributor to contact me regarding the Antiqua Prima Skin Care Products, and acknowledge that these Licensed Professionals require an initial consultation to ensure that the best options are chosen for me, since the Antiqua Prima products are active with specific skin care goals in mind.

	Antiqua Prima Inc.
	Corporate Office: 9759 E. Inglewood Circle Mesa, AZ 85207 480-393-0850	Customer Service: 211 Prather Park Suite B. Myrtle Beach, SC 29588 843.628.7815
	Toll Free 866.358.1694 ° Fax 843.236.1191 sales@antiquaprima.com