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To: Boyce N. Berkel, MD
c/o Unique Enterprises
2330 Kings Point Drive
Largo, FL 33774
Phone: 727-593-5368
Fax: 888-268-2795
Email: painrlfctr@aol.com
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Item#
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Product
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Qty
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Price
Each
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Total
Cost
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2 1/2 oz.
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PainBreak
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1
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$15.97
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FREE
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  (International
Orders: Add extra $3.00 to S/H) |
S/H
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$4.97
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Total
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| Name: | ||||
| Address: | ||||
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| Telephone Number: | ||||
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| E-mail Address: | ||||
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Check
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Money Order
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Credit Card
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| Exp.: |
Visa
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M/C
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Discover
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Amex |
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Credit Card Number:
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| Shipping address if different from above: | ||||
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| Location of pain or shingles: | ||||
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Thank You!
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