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C.O.D. Online Order form 


  1. Please provide the following ordering information:

    Dr. Ben Irvin

    P.O. Box 4014       

    Pocatello, Idaho 83201-4014  

    Telephone (208) 478-4949

    FAX (801) 365-4192

    E-mail me at  this address: birvin@allidaho.com

    OR

    Press the "submit" button to e-mail the completed form to me.  A $4.00 COD service fee will be added for orders submitted via e-mail.

    QTY DESCRIPTION (Blend or Tamper)                       Pouch Size     PRICE

    Add $4.00 C.O.D. service charge for all orders submitted online


    SHIPPING INSTRUCTIONS

    Name

    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Telephone
    E-mail:
 

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Dr. Ben Irvin
Copyright 2000 . All rights reserved.
Revised: December 12, 2004