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Do you
qualify for the $15 Birthday coupon?
- Is your order $200 or more?
- Did you
already place your order and received an order confirmation from PureModa.com?
- Are
you the Cardholder?
- Is it you,
the Cardholder's Birthday Month as per the 12 month calendar year?
- Do you
have a valid photo ID clearly showing your birthdate?
- Are you
able to fax your $15 Birthday Coupon and Photo
Id info request within
24hrs of order confirmation or before we ship you out?
If you answered, Yes
to all the questions above, please
login to your account. Next, fill out the brief form button below.
When you are done
filling this form out, please "add to cart" as if you were placing a new
order with us. Your total will be $0 so no payment information will be
required. Once you are done - print the Birthday Coupon Order Confirmation
along with a copy of your driver's license OR photo ID and FAX TO:
FAX:
1-520-844-6543
PureModa Price: $0.00
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