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Millions Against Medical Madness Order Form
We accept mail orders & orders by phone. To order by mail, Print out this page and fill in the proper boxes for the products you wish to order. Once you have completed this order form, place your check, money order or credit card info. along with this completed form in an envelope with the proper postage and mail to the address below. If paying by credit card please remember to fill in card # and expiration date at the bottom of this order form. To order by phone (626)-963-9463
BAIRD CHIROPRACTIC CENTER,  528 East Route 66, Glendora CA 91741
Products
Price
Quantity
Total
Essential Oil Formula            90 soft gels
$  16.50
Formula 303                            250 tablet
$  54-
Iosol                                          1 fluid ounce
$  17.95
PAV ointment                           1 ounce bottle
$  27.95
NET Remedy 4 fluid ounce - Metal
$  21-
NET Remedy 4 fluid ounce - Earth
$  21-
NET Remedy 4 fluid ounce - Fire
$  21-
NET Remedy 4 fluid ounce - Water
$  21-
NET Remedy 4 fluid ounce - Wood
$  21-
NET Remedy 4 fluid ounce - Flora Plus
$  21-
NET Remedy 4 fluid ounce - 911 remedy
$  21-
NET Remedy 4 fluid ounce - Pain formula
$  21-
NET Remedy 4 fluid ounce - Scars, adhesions
$  21-
NET Remedy 4 fluid ounce - Para solve
$  21-
PLACE ORDER TOTAL HERE >>>>>>>>>>>
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For orders of $ 30 or less please add $ 6 for shipping & handling.
For orders of $ 30 or more please add $10 for shipping & handling.
ORDER TOTAL  >>>>>>>>>>>>
ADD SHIPPING & HANDLING >>
FINAL TOTAL >>>>>>>>>>>>>>
Please Print
Make all checks & money orders payable to:   Baird Chiropractic Center  
NAME
SHIPPING ADDRESS
MC#
                                                                                 Exp.
VISA#
                                                                                 Exp.
Signature
                                                                                 Date:
Phone #
area code(            )
Email (optional)
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