Nature Cure Order Form
P.O. BOX 740
BURTON, OH 44021
Fax: 440-834-8992
Name ____________________________________________
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Date ______________________
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Address __________________________________________
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City _____________________________________________
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State ______________________
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Zip ____________________________
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Phone _____________________
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Form of Payment
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____
Check or Money Order Enclosed
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____Charge My Credit Card
___ Visa
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___ Mastercard
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___ American Express
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___ Discover
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Card # __________________________________
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Expires ______________________
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Signature ___________________________________________________________________
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Item Description
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Quantity
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Unit Price
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Total
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Bee Caps (120 Count)
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Bee Caps Plus (120 Count)
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Bee/Seng (120 Count)
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Apple Cals (120 Count)
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Joint/Renu Plus (120 Count)
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Super MSM (60 Count)
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So-Ho-Mish (50 ml)
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Other:
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| Merchandise
Total > |
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| Shipping
and Handling > |
$5.00 |
| Grand
Total > |
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