Stop
Varicose Veins printable orderform
|
| Customer Name: | |||||||
| Address: | |||||||
|
|||||||
|
|||||||
| Qty | Description | Price | Total | ||||
| proK cream | $25.99 | ||||||
| Venafit tablets | $12.99 |
||||||
| mediK8 skin care system | $99.99 |
||||||
| mediK8 8% vitamin K serum | $39.99 |
||||||
| mediK8 prevention spray | $26.99 |
||||||
| mediK8 cleansing gel | $29.99 |
||||||
| mediK8 muslin cloths | $11.99 |
||||||
| SUBTOTAL: | |||||||
| SALES
TAX: (9.25% in TN) |
|||||||
| SHIPPING (USA ONLY): | $6.99 | ||||||
| TOTAL AMOUNT: | $ | ||||||
| PAYMENT INFORMATION | ||||||||
| PAYMENT TYPE:* (Please select one.) No Cash or C.O.D. accepted. Check/money order payments accepted with postal mail orders ONLY. | ||||||||
|
||||||||
| **
Make checks payable to: Sunset Marketing (checks must be in US dollars
ONLY) CREDIT CARD PAYMENT INFORMATION: |
||||||||
| TYPE OF CARD:* | ||||||||
|
||||||||
|
||||||||
| | | | | | | | | | | | | | | | | | ||||||||
| CARDHOLDER'S NAME AS IT APPEARS ON THE CARD:* | ||||||||
| |
||||||||
| CARDHOLDER'S SIGNATURE:* (Orders can not be processed without signature) | ||||||||
|
||||||||
Mail your order / check payable to:
Sunset Marketing
554 Green Tree Cv
Suite 201
Collierville, TN 38017