Oralflo
Technologies - PILL
CUP ORDER FORM
P.O. Box 222, Dept. 1SH, Raritan,
NJ 08869 Toll-Free: 1-888-843-1631 www.Oralflo.com |
|
Contact
Information |
| NAME: |
|
| STREET
ADDRESS: |
|
| CITY: |
|
| STATE: |
|
ZIP
CODE: |
|
| TEL.
#: |
|
| EMAIL: |
|
|
Product
Information
|
| QUANTITY |
PRICE |
TOTAL
COST |
| |
$9.95 |
|
* $3.00 shipping for up to 3 cups to the U.S. & Canada; please place orders online for other locations
* CANADA Residents - credit card or money order only
* New Jersey residents: add 7% sales tax
NOTE: All orders are shipped via USPS First
Class Mail. On average, it will take 3-5 business
days to receive your cup. We do not offer any other
method of shipping.
|
| TOTAL
ITEM COST: |
|
| 7
% Tax (New Jersey only): |
|
| Shipping
& Handling (see
info to the left): |
|
| TOTAL
COST (incl. S&H and tax): |
|
|
|
Enclosed is my check or money order
for: $ ________________
|
| |
|
Ordering
Information
Print out this form, and mail your completed form,
along with your check or money order made out
to Oralflo Technologies to:
Oralflo Technologies
P.O. Box 222, Dept. 1SH
Raritan, NJ 08869
|
Back to HOME Page
|
|