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Thrift RX Mail Order Form
Contact and billing information:
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Name:
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Street Address:
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Address 2 (if needed)
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City, State and
Zip:
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Country
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E-mail:
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Phone: [ ]
Day or [ ] Evening
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(
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Special instructions:
Order information
(click here to see an example)
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Product Name and
Description
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PRICE
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QUANTITY
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TOTAL
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| Prescription
Guide To Mexico and Canada |
$14.95 |
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| Prescription
Guide To Europe and Canada |
$14.95 |
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| Prescription
Guide To Mexico, Europe and Canada |
$24.95 |
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(Standard Shipping
and handling for
all U.S. 50 states and territories)
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5.00 |
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Subtotal
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Additional Shipping Charge For
Express USPS shipping
U.S. 50 states and territories
(Available only with Money Order)
Add $20.00 |
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(Additional Shipping
and handling Fee for
CANADA ONLY)
(U.S. funds only)
Add $1.00 |
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(Additional Air Mail Shipping and handling for all other countries)
(U.S.
funds only)
Add $4.00
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(Additional Charge For Priority Air Mail Shipping and handling for all other countries)
(U.S. funds only)
Add $20.00 |
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Subtotal
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TOTAL
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Please make your
check or money order payable to
United Publishing,
our order fulfillment company.
Please send check or
money order (U.S. funds only) to:
- Thrift Rx
- P. O. Box 4036
-
Greenville,
DE 19807-
0436
Instructions: Please fill out form as necessary, refer to the example below
if necessary, then
print the above form on your printer. With your mouse
HIGHLIGHT everything above these
instructions. Click the FILE
option in the upper left corner of this screen. Go down the options
to
PRINT option and click it. When the new window opens, click the
SELECTION button.
Then click the OK Button. When the above
form prints out, send it along with payment to
the above address.
SAMPLE
Contact and billing information:
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Name:
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John
Doe
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Street Address:
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5555 Oak Street
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Address 2 (if needed)
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Suite 3B
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City, State and
Zip:
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Mountain Town,
NY 10433
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Country
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USA
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E-mail:
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john@dot.com |
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Phone: [ X ] Day
or [ ] Evening
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( 222 ) 222-2222 |
Special instructions:
| Do not ship Until Monday. I will be
back from my business trip then. Thank you.
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Order information
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Product Name and
Description
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PRICE
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QUANTITY
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TOTAL
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| Prescription
Guide To Mexico and Canada |
$14.95 |
|
|
| Prescription
Guide To Europe and Canada |
$14.95 |
1 |
14.95 |
| Prescription
Guide To Mexico, Europe and Canada |
$24.95 |
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(Standard Shipping
and handling for
all U.S. 50 states and territories)
|
5.00 |
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Subtotal
|
19.95 |
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Additional Shipping Charge For
Express USPS shipping
U.S. 50 states and territories (Available only with Money Order)
Add $20.00 |
|
|
(Additional Shipping
and handling Fee for
CANADA ONLY)
(U.S. funds only)
Add $1.00 |
|
|
(Additional Air Mail Shipping and handling for all other countries)
(U.S.
funds only)
Add $4.00
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|
|
(Additional Charge For Priority Air Mail Shipping and handling for all other countries)
(U.S. funds only)
Add $20.00 |
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Subtotal
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19.95 |
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TOTAL
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19.95 |
(Back to blank order form)
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