Please fill out the following form so that I can determine the best products for your skin, and send samples. 

The cost of this service is $10....  and payment can be made via THIS LINK  (will open in another window for your convenience)

Samples can only be sent to Australian residents.

Please provide as much information as possible in all fields, with as much detail as you can (you cannot provide too much information).  You can type as much information as you want in each field.

If a friend has referred this website - please provide their name (I reward my customers who refer their friends!!!!)

If you have found this website from a website or search - please provide the site name (ie: "blah blah" forum or google or advert on "blah blah").  This helps me to determine the best way to promote Ahava products.

All fields marked with a * are compulsory.           Your details will never be shared with any other party. 

Thank you for taking the time to fill out this form.

* Required fields

Name *

E-mail Address *

Address: *

Suburb, State & Postcode:

Mobile phone:

Landline phone:

How did you hear about us? (please specify "friends" name - or website name that referred you here) * *

Your Age *

Are you a smoker? * no yes - regular yes - occasional

How do you describe your skin condition and/or skin problems? *

What concerns you the most with your skin?

What products do you currently use (brand & products... eg: toner, exfoliant day/night cream) *

What do you cleanse with? Does it feel tight after cleansing?

Is your skin/T-zone oily throughout the day or at the end of day?

Are you on any medication (eg: pill, roaccutane etc)?

How much water would you drink per day (on average)?

Do you have any allergies or particularly "sensitive" skin? *

Do you wear make-up regularly?

Are you pregnant/recently been pregnant?

Do you live and/or work in air conditioned/heated premises?

How is the skin on your body, hands & feet?

Would you like any particular samples sent? (Toners, cleansing milk, shampoos, conditioner, salts & mud not available)

Any further comments?

how will you make the $5 payment? * visa/mastercard paypal bank deposit other

I have read and agree to the Privacy Policy *

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Ahava have recently "rebranded".  For details, visit this page:  Ahava changes

Spend $50 to be eligible for the Weekly Wonder SUPER SPECIAL item !!

email: info@deadsea.com.au N Phone: 1800 226 409 press this link to   Add site to favourites

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