Customer # Date Name Address (Ship to) Order Form City, State, Zip 877.PCA.SKIN [722.7546] Fax 480.946.5690 pcaskin.com Phone Effective Jan 2, 2017 Daily care products cleanse Size 7 oz. 21101 $15.50 Facial Wash 1 oz. 22201 $3.50 7 oz. 21102 $15.50 Facial Wash Oily/Problem 1 oz. 22202 $3.50 7 oz. 21401 $15.50 Total Wash Face & Body Cleanser 1 oz. 22401 $3.00 7 oz. 21124 $15.50 Creamy Cleanser 1 oz. 22224 $3.25 7 oz. 21170 $18.50 BPO 5% Cleanser 1 oz. 22270 $3.50 Blemish Control Bar 3.4 oz. 21178 $19.50 Dry Skin Relief Bar 3.4 oz. 21158 $19.50 Pigment Bar 3.4 oz. 21151 $19.50 Daily care products tone Size 7 oz. 21103 $17.00 Smoothing Toner 1 oz. 22203 $3.00 4.4 oz. 21104 $17.50 Nutrient Toner 1 oz. 22204 $4.75 Daily care products correct Size 7 oz. 21107 $15.50 Gentle Exfoliant 1 oz. 22207 $3.00 2.1 oz. 21127 $29.00 Purifying Mask.25 oz. 22228 $8.00 2.1 oz. 21126 $29.00 Revitalizing Mask.25 oz. 22226 $8.00 1 oz. 21144 $54.00 ExLinea Peptide Smoothing Serum.17 oz. 22242 $13.50 1 oz. 21115 $27.50 Pigment Gel.25 oz. 22215 $6.00 1 oz. 21118 $27.50 Pigment Gel HQ Free.25 oz. 22218 $8.50 1 oz. 21175 $22.50 Acne Gel.25 oz. 22276 $6.00.5 oz. 21174 $13.00 Acne Cream.25 oz. 22274 $6.00 1 oz. 21130 $37.50 C-Quench Antioxidant Serum.17 oz. 22230 $9.50 1 oz. 21140 $41.50 A&C Synergy Serum.17 oz. 22240 $10.25 1 oz. 21411 $44.50 Total Strength Serum.17 oz. 22411 $10.75 1 oz. 21148 $37.00 Hydrating Serum.17 oz. 22248 $10.75 1 oz. 21143 $42.50 Rejuvenating Serum.17 oz. 22243 $10.25 1 oz. 21146 $30.50 Anti-Redness Serum.17 oz. 22246 $8.25 1.1 oz. 21147 $45.00 Retinol Renewal with RestorAtive Complex.18 oz. 22247 $12.00 1 oz. 21180 $54.50 Intensive Clarity Treatment : 0.5% pure retinol night.07 oz. 23380C $9.00 1 oz. 21179 $54.50 Intensive Age Refining Treatment : 0.5% pure retinol night.07 oz. 23379C $9.00 1 oz. 21181 $54.50 Intensive Brightening Treatment: 0.5% pure retinol night.07 oz. 23381C $9.00.5 oz. 21182 $72.50 Intensive Pigment Eraser exlusively sold through physicians.07 oz. 23382 $10.00 1 oz. 21165 $46.50 C&E Strength.25 oz. 22265 $11.50 1 oz. 21166 $48.50 C&E Strength Max.25 oz. 22266 $11.50 1 oz. 21149 $57.50 Dual Action Redness Relief.17 oz. 22249 $20.00.5 oz. 21114 $42.50 Ideal Complex Revitalizing Eye Gel.125 oz. 22214 $10.00.5 oz. 21113 $42.50 Ideal Complex Restorative Eye Cream.125 oz. 22213 $10.25.5 oz. 21112 $25.00 EyeXcellence.125 oz. 22212 $5.75 3 oz. 21164 $39.50 Perfecting Neck & Décolleté.25 oz. 22264 $3.75 2.1 oz. 21168 $23.50 CliniCalm 1%.25 oz. 22268 $4.00 Peptide Lip Therapy.3 oz. 21167 $12.00 877.PCA.SKIN(722.7546) Fax Page 1480.946.5690 Total pcaskin.com Page 1 of 6
Daily care products hydrate & protect Weightless Protection Broad Spectrum SPF 45 Perfecting Protection Broad Spectrum SPF 30 Protecting Hydrator Broad Spectrum SPF 30 Hydrator Plus Broad Spectrum SPF 30 Active Broad Spectrum SPF 45: Water Resistant Size 2.1 oz. 21132 $21.50.25 oz. 22232 $3.25 1.7 oz. 21137 $17.50.25 oz. 22237 $2.50 1.7 oz. 21110 $17.50.25 oz. 22210 $3.75 1.7 oz. 21109 $17.50.25 oz. 22209 $2.50 3 oz. 21138 $17.50.25 oz. 22238 $3.50 Sheer Tint Broad Spectrum SPF 45 1.7 oz. 21139 $24.50 Clearskin ReBalance Après Peel Hydrating Balm Collagen Hydrator Silkcoat Balm Body Therapy Daily Care Solutions [Trial-Size] 1.7 oz. 21134 $21.00.25 oz. 22234 $4.00 1.7 oz. 21133 $21.00.25 oz. 22233 $4.00 1.7 oz. 21161 $21.00.25 oz. 22261 $3.50 1.7 oz. 21108 $21.00.25 oz. 22208 $3.00 1.7 oz. 21135 $21.00.25 oz. 22235 $4.00 7 oz. 13739 $30.00 1.1 oz. 22239 $5.00 The Post-Procedure Solution includes Facial Wash, CliniCalm 1%, Perfecting Protection Broad Spectrum SPF 30, ReBalance, Silkcoat Balm 22155 $19.00 The Acne Kit includes BPO 5% Cleanser, Acne Cream, Intensive Clarity Treatment: 0.5% pure retinol night, Weightless Protection Broad Spectrum SPF 45, Clearskin The Anti-Aging Kit includes ExLinea Peptide Smoothing Serum, C&E Strength Max, Intensive Age Refining Treatment : 0.5% pure retinol night, Hydrator Plus Broad Spectrum SPF 30, Collagen Hydrator The Sensitive Skin Kit includes Hydrating Serum, Anti-Redness Serum, Retinol Renewal with RestorAtive Complex, Protecting Hydrator Broad Spectrum SPF 30, ReBalance 16003 16004 16006 $20.00 $30.00 $27.50 The Discoloration Kit includes Pigment Gel, C&E Strength Max, Intensive Brightening Treatment: 0.5% pure retinol night, Perfecting Protection Broad Spectrum SPF 30, ReBalance 16007 $27.50 The Preventative Kit includes C&E Strength, Rejuvenating Serum, Retinol Renewal with RestorAtive Complex, Protecting Hydrator Broad Spectrum SPF 30, ReBalance 16008 $27.50 The Solution for Chemotherapy and Radiation Therapy Support includes Creamy Cleanser, Hydrating Serum, Anti-Redness Serum, Perfecting Protection Broad Spectrum SPF 30, ReBalance, Silkcoat, CliniCalm 1%, Peptide Lip Therapy 22105 $41.50 Daily care regimens Size 43100 $72.00 The Acne Control Regimen includes BPO 5% Cleanser, Acne Cream, Intensive Clarity Treatment : 0.5% pure retinol night, Clearskin Daily Care Products Back Bar Size (pump included) Facial Wash Facial Wash Oily/Problem Smoothing Toner Nutrient Toner Size 16 oz. 13501 $28.00 16 oz. 13502 $28.50 16 oz. 13503 $30.00 16 oz. 13504 $50.00 CliniCalm 1% 7 oz. 13768 $58.00 Weightless Protection Broad Spectrum SPF 45 7 oz. 13732 $58.00 Perfecting Protection Broad Spectrum SPF 30 Hydrator Plus Broad Spectrum SPF 30 7 oz. 13737 $51.00 7 oz. 13709 $56.00 Clearskin 7 oz. 13734 $56.00 ReBalance 7 oz. 13733 $56.00 Page 2 Total
Professional Treatments (least to most active) Enhanced Jessner's Treatments PCA Peel Hydroquinone Free PCA Peel with Hydroquinone PCA Peel with Hydroquinone and Resorcinol Size 2 oz. 11225 $69.50.25 oz. 12325 $8.00 2 oz. 11222 $69.50 4 oz. 11230 $134.00.25 oz. 12322 $8.00 2 oz. 11224 $69.50 4 oz. 11231 $134.00.25 oz. 12324 $8.00 Blended TCA Peels Sensi Peel Ultra Peel I Ultra Peel Forte for physicians' use only Smoothing Body Peel Treatment (Steps 1 2) 2 oz. 11263 $79.50 4 oz. 11264 $154.00.25 oz. 12363 $10.00 2 oz. 11252 $79.50 4 oz. 11250 $154.00.25 oz. 12350 $10.00 2 oz. 11275 $93.75.25 oz. 12375 $12.00 full-size 11240 $228.25 trial-size 12343 $59.50 4 oz. 11241 $83.25 1 oz. 12341 $19.75 4 oz. 11242 $163.25 1 oz. 12342 $39.75 Therapeutic Mask Series Professional Treatments (cont.) Therapeutic Mask Treatment (full-size and trial-size) Mask Mini Suite includes: Hydrate Oat Milk Mask.25 oz., Revitalize Papaya Mask.25 oz., Clarify Salicylic Acid Mask.25 oz., Retexturize Pumpkin Mask.25 oz., Calming 4 oz. 11385 $46.00.30 oz. 12385 $3.50 4 oz. 11386 $46.00.30 oz. 12386 $3.50 4 oz. 11388 $46.00.30 oz. 12388 $3.50 4 oz. 11387 $46.00.30 oz. 12387 $3.50 Size full-size 41115 $127.00 trial-size 41215 $9.75 full-size 41116 $127.00 trial-size 41216 $9.75 full-size 41118 $127.00 trial-size 41218 $9.75 full-size 41117 $127.00 trial-size 41217 $9.75 trial-size 41219 $20.25 Balm.25 oz., Replenishing Gel.25 oz. Retinoid Treatments 1.7 oz. 11382 $185.00.07 oz. 13382 $13.00 6% Pure Retinol Peel 10 packettes 11276 $300.00 Oxygenating Trio (Steps 1 3) Oxygenator (Step 3) Detox Gel Deep Pore Treatment full-size 11335 $126.00 trial-size 12235 $60.00 4 oz. 11336 $42.00 1 oz. 12236 $20.00 4 oz. 11337 $42.00 1 oz. 12237 $20.00 4 oz. 11338 $42.00 1 oz. 12238 $20.00 4 oz. 11384 $87.00.25 oz. 12384 $6.00 Treatment Enhancements Replenishing Gel Calming Balm Pre-Peel Accelerator Mask (Step 1) Smoothing Body Peel (Step 2) Hydrate: Therapeutic Oat Milk Mask Revitalize: Therapeutic Papaya Mask Clarify: Therapeutic Salicylic Acid Mask Retexturize: Therapeutic Pumpkin Mask Hydrate: Therapeutic Oat Milk Mask Treatment includes Hydrate Mask, Revitalize: Therapeutic Papaya Mask Treatment includes Revitalize Mask, Clarify: Therapeutic Salicylic Acid Mask Treatment includes Clarify Mask, Retexturize: Therapeutic Pumpkin Mask Treatment includes Retexturize Mask, Advanced Treatment Booster Activator (Step 1) Detoxifier (Step 2) 3.3 oz. 11389 $37.00.30 oz. 12389 $3.00 3.3 oz. 11390 $44.00.30 oz. 12390 $3.25 Page 3 of 6 Page 3 Total
Professional Treatments [Trial-Size sets] *clear travel bag and protocol included Enhanced Jessner's Peels PCA Peel Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, PCA Peel with Hydroquinone, Pigment Gel, ReBalance, Perfecting Perfection Broad Spectrum SPF 30 12353 $40.00 Blended TCA Peels Sensi Peel Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Sensi Peel, Rejuvenating Serum, ReBalance, Perfecting Protection Broad Spectrum SPF 30 12364 $38.50 Ultra Peel I Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Ultra Peel I, ExLinea Peptide Smoothing Serum, ReBalance, Perfecting Protection Broad Spectrum SPF 30 12352 $45.00 Ultra Peel Forte Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Ultra Peel Forte, ReBalance, Perfecting Protection Broad Spectrum SPF 30 12360 $34.00 Smoothing Body Peel Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Pre-Peel Accelerator Mask (Step 1), Smoothing Body Peel (Step 2), Perfecting Protection Broad Spectrum SPF 30 12340 $68.00 Therapeutic Masks Hydrate: Therapeutic Oat Milk Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Hydrate Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Revitalize: Therapeutic Papaya Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Revitalize Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Clarify: Therapeutic Salicylic Acid Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Clarify Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Retexturize: Therapeutic Pumpkin Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Retexturize Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Peel Alternative Treatments Oxygenating Trio Set includes Facial Wash Oily/Problem, Smoothing Toner, Activator (Step 1), Detoxifier (Step 2), Oxygenator (Step 3), ReBalance, Perfecting Protection Broad Spectrum SPF 30 Detox Gel Set Deep Pore Treatment includes Facial Wash Oily/Problem, Smoothing Toner, Detox Gel Deep Pore Treatment, Acne Gel, A&C Synergy Serum, Clearskin, Perfecting Protection Broad Spectrum SPF 30 Miscellaneous Supplies PCA SKIN Lab Coat - black (available in sizes XS, S, M, L, XL) PCA SKIN Lab Coat - white (available in sizes XS, S, M, L, XL) 41223 $18.50 41220 $18.50 41222 $18.50 41221 $18.50 12239 $72.00 12366 $34.00 62000 $44.50 62010 $44.50 Fan Brush - small 10500 $7.00 Fan Brush - medium Fan Brush - large Peel Dish Cotton Squares (4x4) (pack of 100) Disposable Headbands (pack of 24) PCA SKIN Fan Pump for 16 oz. Bottle Sponges - Blemish Control, Pigment Control Bar & Dry Skin Relief Bar (pack of 3) Spatula Trial-Size Solution Clear Travel Bag Wood's Lamp White Light Tube for Wood's Lamp 10533 $7.00 10534 $9.00 10545 $2.00 10538 $6.50 10539 $13.00 10609 $1.75 06206 $1.00 10604B $2.00 10606 $0.10 10578 $2.50 10530 $279.00 10531 $15.00 Black Light Tube for Wood's Lamp 10532 $16.00 Page 4 of 6 Page 4 Total
Marketing Collateral Marketing Package - Full (includes items below) Patient Brochure (set of 25), Before & After Booklet (set of 5), Acrylic Brochure Stand, PCA SKIN Retail Logo Bag - small (set of 25 white w/tissue), "Recommended by The Skin Cancer Foundation" Poster (18"x24"), "What to Expect from a PCA SKIN Peel" Poster (18"x24"), PCA SKIN notecard & envelope (set of 10), Daily Regimen Pad, Treatment Options for Healthy Skin Brochure (set of 25), "What to Expect from a PCA SKIN Peel" Brochure (set of 25) Marketing Package - Select ( includes items below) 10625 $66.00 Patient Brochure (set of 25), Before & After Booklet (set of 5), acrylic brochure stand, PCA SKIN Retail Logo Bag - small (set of 25 white w/tissue), "What to Expect from a PCA SKIN Peel Poster" (18"x24"), What to Expect from a PCA SKIN Peel Brochure (set of 25) 10621 $45.00 Before & After Booklet PCA SKIN Summer-Friendly Protocols Booklet PCA SKIN Standard Treatment Protocols Booklet Daily Regimen Pad (1 pad of 25 carbon copy sheets) Patient Brochure (Set of 25): Order of $1-$499 Patient Brochure (Set of 25): Order of $500+ Pre & Post-Treatment Brochures (Set of 25) PCA SKIN Retail Logo Bag - small (Set of 25 white with tissue) PCA SKIN Retail Logo Bag - medium (Set of 10 black with tissue) 10536 10740 $2.00 10741 $2.00 10735 $7.50 10529 $10.75 10529 $5.50 10522 $10.75 10552 $5.50 10572 $3.60 PCA SKIN Logo Tissue Paper (25 sheets) 23000 $1.50 PCA SKIN Product Postcard (set of 25) 10554PCA $3.75 PCA SKIN Notecard & Envelope (set of 10) 10736 $2.75 Acrylic Stand w/ Clear Display 10595 $40.00 Before & After Flip Chart 10781 $50.00 Product Catalogue 10715 SPF Trifold 10817 Brochure Single Sampler TRI99999 Poster Series What to Expect from a PCA SKIN Peel (Fitz I-VI) 18"x24" POS11000L $10.00 What to Expect from a PCA SKIN Peel (Fitz I-VI) 11"x14" POS11000S $6.00 The Essentials of Skin Health: The Peel (Fitz I-III) 18"x24" POS11004L $10.00 The Essentials of Skin Health: The Peel (Fitz I-III) 11"x14" POS11004S $6.00 The Essentials of Skin Health: The Peel (Fitz IV-VI) 18"x24" POS11005L $10.00 The Essentials of Skin Health: The Peel (Fitz IV-VI) 11"x14" POS11005S $6.00 The Essentials of Skin Health: The Peel (Men) 18"x24" POS11006L $10.00 The Essentials of Skin Health: The Peel (Men) 11"x14" POS11006S $6.00 Treatment Essentials for Age Defense (Fitz I-III) 18"x24" POS11007L $10.00 Treatment Essentials for Age Defense (Fitz I-III) 11"x14" POS11007S $6.00 Treatment Essentials for Acne Control (Fitz I-III) 18"x24" POS11011L $10.00 Treatment Essentials for Acne Control (Fitz I-III) 11"x14" POS11011S $6.00 Treatment Essentials for Acne Control (Fitz IV-VI) 18"x24" POS11012L $10.00 Treatment Essentials for Acne Control (Fitz IV-VI) 11"x14" POS11012S $6.00 Treatment Essentials for Acne Control (Men) 18"x24" POS11013L $10.00 Treatment Essentials for Acne Control (Men) 11"x14" POS11013S $6.00 Treatment Essentials for Achieving Even Pigment (Fitz I-III) 18"x24" POS11009L $10.00 Treatment Essentials for Achieving Even Pigment (Fitz I-III) 11"x14" POS11009S $6.00 Treatment Essentials for Achieving Even Pigment (Fitz IV-VI) 18"x24" POS11010L $10.00 Treatment Essentials for Achieving Even Pigment (Fitz IV-VI) 11"x14" POS11010S $6.00 Poster Series (cont'd) Treatment Essentials for Sensitive Skin (Fitz I-III) 18"X24" POS11014L $10.00 Treatment Essentials for Sensitive Skin (Fitz I-III) 11"X14" POS11014S $6.00 Recommended by The Skin Cancer Foundation 18"X24" POS11016L $10.00 Recommended by The Skin Cancer Foundation 11"X14" POS11016S $6.00 Minimum Effort. Maximum Results. 18"X24" POS10506L $10.00 Page 5 of 6 Page 5 Total
Brochure Series What to Expect from a PCA SKIN Peel (Fitz I-VI) (Set of 25 brochures) Treatment Essentials for Age Defense (Fitz I-III) (Set of 25 brochures) Treatment Essentials for Acne Control (Fitz I-III) (Set of 25 brochures) Treatment Essentials for Acne Control (Fitz IV-VI) (Set of 25 brochures) Treatment Essentials for Acne Control (Men) (Set of 25 brochures) Treatment Essentials for Achieving Even Pigment (Fitz I-III) (Set of 25 brochures) Treatment Essentials for Achieving Even Pigment (Fitz IV-VI) (Set of 25 brochures) Treatment Essentials for Sensitive Skin (Fitz I-III) (Set of 25 brochures) Recommended by The Skin Cancer Foundation (Set of 25 brochures) Monthly Promotion TRI11000-25 $4.50 TRI11007-25 $4.50 TRI11011-25 $4.50 TRI11012-25 $4.50 TRI11013-25 $4.50 TRI11009-25 $4.50 TRI11010-25 $4.50 TRI11014-25 $4.50 TRI11016-25 $4.50 Holiday promo: ExLinea Peptide Smoothing Serum, Ideal Complex Restorative Eye Cream and an exlusive PCA SKIN travel bag. 1116A $45.00 Holiday promo: Rejuvenating Serum, Ideal Complex Revitalizing Eye Gel and an exlusive PCA SKIN travel bag. 1116B $45.00 Holiday promo: Hydrating Serum, Ideal Complex Revitalizing Eye Gel and an exclusive PCA SKIN travel bag. 1116C $45.00 Page 6 of 6 Page 6 Total Credit Card Payment CC # Subtotal Exp. Date Estimated Shipping $9.00 echeck Acct Holder Check # Routing # Grand Total Shipping Options (please delete all except your selection) Acct # Overnight 2nd day 3 day Ground Please note: Free shipping applies to single orders over $1,000 (regular ground in the USA). Return policy is 60 days from the date of invoice. Trial-size & monthly promotional products are not returnable. Returned products are subject to a 20% restocking fee. rev 112515LT