Print
This Form For Fax/Mail Orders
Special "Get Acquainted" Offer!
3 For 1 Offer!
To: Boyce N. Berkel, MD
c/o Unique Enterprises
2330 Kings Point Drive
Largo, FL 33774
FAX: 888-268-2795
email: painrlfctr@aol.com
For Fast Secure Online Ordering Click Here
Special "Get Acquainted" Offer!
3 For 1 Offer!
To: Boyce N. Berkel, MD
c/o Unique Enterprises
2330 Kings Point Drive
Largo, FL 33774
FAX: 888-268-2795
email: painrlfctr@aol.com
For Fast Secure Online Ordering Click Here
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Item#
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Product
|
Qty
|
Price
Each
|
Total
Cost
|
|
2 1/2 oz.
|
PainBreak
|
2
|
$15.97
|
$31.94
|
|
2 1/2 oz.
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PainBreak
|
1
|
$15.97
|
FREE
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S/H
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$5.97
|
|||
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Total
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$37.91
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| Name: | ||||
| Address: | ||||
| City: | ||||
| State: | Zip Code: | Country: | ||
| Telephone Number: | ||||
| Fax Number: | ||||
| E-mail Address: | ||||
| Payment Type |
Check
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Money Order
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Credit Card
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| Exp. |
Visa
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M/C
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Discover
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Amex |
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Credit Card Number:
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| Shipping address if different from above: | ||||
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| Location of pain or shingles: | ||||
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Thank You! |
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