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Unique
Enterprises
Fax Order Form |
Boyce
N. Berkel, MD
2330 Kings Point Dr.
Largo, Florida 33774
FAX:888-268-2795
Email: painrlfctr@aol.com
24
Hour Automated Order Line!
1-888-268-2795 |
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Name: |
Address: |
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City |
State: |
Zip: |
Visa |
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Discover |
Amex |
(circle one) |
Check/Money Order |
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Comments: |
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Item |
Product |
Quantity |
S/H |
Price Each |
Total Cost |
Tube (2.5 oz) |
PainBreak |
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$4.97 |
$15.97 |
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3 for 2 |
PainBreak Special |
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$5.97 |
$31.97 |
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6 tubes |
Excellent Value |
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$8.97 |
$77.82 |
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12 Tubes |
Best Value |
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$12.97 |
$119.64 |
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Capsules |
LarreaRX |
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$4.97 |
$32.97 |
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Book |
Living With Shingles |
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$8.97 |
$19.97 |
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Sub |
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Shipping and Handling
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Date:
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Total |
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