| Home | What's New | Sleep Studies | Order Online | Strip Applied | Contact Us |
|
Chin-Up StripsŪ - Volume discount prices & shipping- 01/01/2013 |
Dale Miller, Inc. |
|
| Call 1-888-835-4563 or print & fax order 1-678-298-9988 | DATE:_______________ |
| NAME: | _______________________________________________________________________ | ||||
| ADDRESS: | _______________________________________________________________________ | ||||
| CITY: | __________________________________ | STATE: | _______ | ZIP: | ______________ |
| EMAIL: | _____________________________________ | PHONE#: | ___________________ | ||
| SEND BROCHURES? ___YES HOW MANY _______ | P.O.#: | ___________________ | |||
| 30 ct. pks - 300 ct pks - 500 ct rolls | Quantity: | Price | US-S/H | Subtotal |
|
___ WHITE
Horseshoe (#11130) |
_____ 30ct. Packs | $14.99 | $3.00 | $__________ |
|
___ TAN
Horseshoe (#22230) |
_____ 30ct. Packs | $14.99 | $3.00 | $__________ |
|
___ TAN
Boomerang (#33330) |
_____ 30ct. Packs | $14.99 | $3.00 | $__________ |
| ___ Tan Horseshoe Roll (#22500) 500 strips - Ship UPS Ground | $169.99 | $9.99 | $__________ | |
| ___ Tan Boomerang Roll (#33500) 500 strips - Ship UPS Ground | $169.99 | $9.99 | $__________ | |
|
Quantity: |
Price | US-S/H | Subtotal | |
| ___ White Horseshoe (#11130) | _____ 300 strips 10 pks | $139.90 | $3.00 | $__________ |
___ Tan Horseshoe (#22230) ___ Tan Boomerang (#33330) |
_____ 300 strips 10 pks
_____ 300 strips 10 pks |
$139.90 $139.90 |
$3.00 $3.00 |
$__________ $__________ |
| ReliaMed | Quantity: | Price | US-S/H | Subtotal |
| ___ Adhesive Remover Wipes | _____ 50ct. Packs | $13.00 | $3.00 | $__________ |
| ___ Skin Protective Barrier Wipes | _____ 50ct. Packs | $13.00 | $3.00 | $__________ |
| * * * Email: dmiller176@aol.com for shipping cost outside US 48 states | $__________ | |||
| GA Residents Only - Sales Tax @ 6.0% | $__________ | |||
| Send Check or use Credit Card - TOTAL | $__________ | |||
| * * * Approved credit account companies agree to pay their PO within 30 days from date of delivery. | ||||
| Credit Card #_____________________________________________________________________ |
| Card Type: ____ Visa ____ MasterCard ____ AmEx ____ Discover Exp. Date: _____________ |
| Name on Card:____________________________________________________________________ |