TOTAL # OF ITEMS ORDERED
(see note) TAX TOTAL
(see chart) SHIPPING TOTAL
GRAND TOTAL $
Should you be unable to find items you wish to order on this list, please
call
our office @ (626) 966-1618, or email
your request to us. We have many more products available and if we
don't have it, we will try to get it for you.
Shipping Charges:
1 Item - $4.00
2-6 Items - $5.00
7 or More Items - $9.00
Tax Information:
If you are not a patient of Dr. Privitera's and live in the state of
California, you must add 8.25% state sales tax to your order.
Mailing Label:
Other Information Needed:
Phone Day:
Phone Night:
Fax:
Special Instructions for Shipping:
Payment options:
* Currently we do not accept on-line transactions,
but we can accept credit card numbers via fax
or regular mail.
Credit Card: _______________________
Number:___________________________
By Mail:
Send Check, Money Order, Cashiers Check, or
Credit Card number & info to:
Dr. James Privitera M.D.
Nutriscreen, Inc.
256 W. San Bernardino Rd.
Covina, Ca. 91724
