| Full
Name:_____________________________________________________ |
| Street
address :_________________________________________________ |
| ______________________________________________________________ |
| Phone:____________________
Fax: ____________________________ |
| E-mail:_________________________ |
| Product Name: |
Retail: |
Quantity: |
| Neu-Becalm'd
90 Cap |
$37.50 |
______ |
4-Neu-BeCalm'd
(Free Encore & Free Shipping!) |
$135.00 |
______ |
| Neu-Becalm'd Chewable
-90 Tabs |
$35.50 |
______ |
4-Neu-Becalm'd Chewables
(Free Encore & Free Shipping) |
$128.00 |
______ |
| Encore Optima
-60 Cap |
$27.00 |
______ |
3-Encore Optima
(Plus 1-Free Encore & Free Shipping |
$73.50 |
______ |
| Neu-Relieve 90
Cap |
$34.00 |
______ |
4-Neu-Relieve
(Free Encore & Free Shipping) |
$122.00 |
______ |
* Include
shipping and handling.
(For Orders Under $50.00) |
S
& H |
______ |
| |
Total:
|
______ |
|
Shipping and Handling |
| 1-4 Bottles |
$7.05 |
| 5-8 Bottles |
$7.90 |
| 9-12 Bottles |
$10.75 |
|
Over 12 bottles or outside of USA shipping
prices will vary. |
|
|
All prices are in US dollars.
|
| Card
Type:___________________________________ |
| Card
Number:________________________________ |
| Expiration
Date:___________ |
| Name
on Card:__________________________________ |
| Message:________________________________________________________ |
| ________________________________________________________________ |
|