payment-v1 – DRMA

Medical questions
Order Confirmation
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Credit card information

Note: Your card will only be pre-authorized at this time. Once our doctors have reviewed and approved your order, your card will be charged and you'll receive your order in the mail.

NAME ON CARD *

CARD NUMBER*

EXPIRATION MONTH *

EXPIRATION YEAR *

SECURITY CODE*

ADDRESS *

ZIP CODE *

CITY *

STATE *

Click here if shipping address is different than billing address.

First Name*

Last Name*

ADDRESS *

ZIP CODE *

CITY *

STATE *

By clicking confirm order you agree that, if prescribed, you will be charged for your first shipment of your customized anti-aging cream and that same amount every month thereafter until you cancel. You can cancel your plan anytime by logging into your account and messaging us or email our customer service at support@dermy.com