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| Pain Bugs Book Order Form |
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Simply print this page, fill out the information and mail it to the address shown below along with check for $19.95 ($14.95 for the book and $5.00 for shippingand handling). Please make checks payable to Hippocrates, Inc. Hippocrates, Inc. |
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Name:
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_________________________________________________ |
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Address:
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_________________________________________________ |
| _________________________________________________ | |
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Shipping Address:
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_________________________________________________ |
| _________________________________________________ | |
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City:
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_________________________________________________ |
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State:
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_________________________________________________ |
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ZIP:
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_______________ |
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Phone Number:
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_______________ |
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| Please allow 4 to 6 weeks for delivery. |