Oralflo
Technologies - PILL
CUP ORDER FORM
P.O. Box 222, Dept. 1SH, Raritan,
NJ 08869 Toll-Free: 1-888-843-1631 www.Oralflo.com |
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Contact
Information |
| NAME: |
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| STREET
ADDRESS: |
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| CITY: |
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| STATE: |
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ZIP
CODE: |
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| TEL.
#: |
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| EMAIL: |
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Product
Information
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| QUANTITY |
PRICE |
TOTAL
COST |
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$14.95 |
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* $3.50 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.
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| TOTAL
ITEM COST: |
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| 7
% Tax (New Jersey only): |
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| Shipping
& Handling (see
info to the left): |
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| TOTAL
COST (incl. S&H and tax): |
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Enclosed is my check or money order
for: $ ________________
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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
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