ORDER FORM
For security reasons, please call in your order or print order form and send to:
Podiatry Projections
1909 24th St, Anacortes, WA 98221
Call: 1-360-299-2322 or E-Mail:
Joanie Cox
Date:_____________________
PRODUCT: Podiatry X-Ray Manual and Video
CONTACT NAME:____________________________________________________________
DR OR CO. NAME:____________________________________________________________
ADDRESS:___________________________________________________________________
CITY:________________________________STATE:________________ZIP:_____________
PHONE:___________________________________EXT.______________________________
QTY:_______________
Manual & Video: $65.00 + 6.00 S/H ($71.00 Total)
Manual only: $35.00 + $6.00 S/H ($41.00 Total)
WA. Res Only: add 7.8% tax.
TOTAL:____________
VISA/MC#:_____________________________________________EXP. DATE:___________
COMMENTS:_________________________________________________________________
_____________________________________________________________________________
