Product
Blend
name Tamper Description or Art
Pouch Size
Price
Qty.
TOTAL
SHIP TO:
Name:
Company:
Address:
City, State, Zip:
SUBTOTAL:
Work Phone:
$4.00
charge if COD :
Home Phone:
$4.50 Shipping and Handling if under
$45.00
TOTAL:
It's Easy to Order:
By Phone:
(208) 478-4949 or
FAX this form to: (801) 365 4192.
By Check: Just complete this form and send it to us with your payment to Dr. Ben Irvin’ address at the top of the page.
Free Shipping on orders over $45.00
COD Orders add $4.00
Dr. Ben's Home Page
Online Order
Dr. Ben Irvin
PO Box 4041
Pocatello, ID 83201-4014
Phone (208) 478-4949
Fax (801)
365 4192