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
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BAIRD CHIROPRACTIC CENTER, 1779 East Route 66, Glendora CA 91741
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Products
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Price
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Quantity
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Total
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Chestal 250 ml. bottle
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$ 14-
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Clear Lung 120 capsules
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$ 38-
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Gena Flora 150 capsules
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$ 39-
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Kiddi Flora 60 wafers
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$ 21-
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EZ Flex 60 tablet
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$ 18.50
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Essential Oil Formula 90 soft gels
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$ 16.50
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Formula 303
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$ 30-
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That Stuff lotion
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$ 15-
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Iosol 1 fluid ounce
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$ 17.95
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Phytogest cream 2 ounce
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$ 20-
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PAV ointment 1 ounce bottle
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$ 21.95
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Osilloccocinum 6 doses
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$ 14-
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Olive leaf extract 60 500mg. caps.
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$ 38-
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XClear nasal spray
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$ 16.50
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Sambucal 120 ml. bottle
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$ 11.95
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NET Remedy 4 fluid ounce - Metal
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$ 19-
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NET Remedy 4 fluid ounce - Earth
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$ 19-
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NET Remedy 4 fluid ounce - Fire
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$ 19-
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NET Remedy 4 fluid ounce - Water
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$ 19-
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NET Remedy 4 fluid ounce - Wood
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$ 19-
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NET Remedy 4 fluid ounce - Flora Plus
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$ 19-
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NET Remedy 4 fluid ounce - 911 remedy
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$ 19-
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NET Remedy 4 fluid ounce - Pain formula
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$ 19-
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NET Remedy 4 fluid ounce - Scars, adhesions
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$ 19-
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NET Remedy 4 fluid ounce - Para solve
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$ 19-
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PLACE ORDER TOTAL HERE >>>>>>>>>>>
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>>>>>>>>
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>>>>>>>>>>>>>
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For orders of $ 30 or less please add $ 6 for shipping & handling.
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For orders of $ 30 or more please add $10 for shipping & handling.
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ORDER TOTAL >>>>>>>>>>>>
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ADD SHIPPING & HANDLING >>
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FINAL TOTAL >>>>>>>>>>>>>>
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Please Print
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Make all checks & money orders payable to: Baird Chiropractic Center
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NAME
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SHIPPING ADDRESS
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MC#
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Exp.
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VISA#
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Exp.
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Signature
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Date:
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Phone #
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area code( )
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Email (optional)
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