Fax Order Form
30725 US HWY 19 N Suite 344
Palm Harbor, Florida 34684
FAX: (727) 754-2549
Email: painrlfctr@aol.com
24 Hour Automated Order Line!
1-888-268-2795
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(circle one)
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Visa
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Amex
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Item
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Product
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Quantity |
S/H
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Price Each
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Total Cost
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| 1 Tube (2.5 oz) | PainBreak | $6.97 | $19.97 | ||
| 6 Tubes | Excellent Value | $14.97 | $107.84 | ||
| 12 Tubes | Best Value | $18.97 | $203.69 | ||
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Book
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Post Herpetic
Neuralgia
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$5.97
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$29.97
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Sub
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Total
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