Request



Fill in this form and we’ll deliver a Lactacyd sample right to your doorstep!

Name:


Identification Card Number:


Email:


Contact No.:


Ethnicity:


Do you currently use feminine wash?


What brand do you use most often?


Variant


Date of birth:


Address:



Postcode:


State:


Country:


Do you share it with anyone at home?


What other brands do you use?


Variant



I hereby agree to the Terms and Conditions stated and consent to the use of my personal data in the manner and for the purposes stipulated in the PDPA.
I would like to be part of the upcoming V-Royalty program to enjoy special Lactacyd privileges and promotions.