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Bartles
Pharmacy Phone:
|
Mail in Order
Form
|
Bartles
Pharmacy 9 E. State St., Oxford, New York 13830 |
FOR FASTER SERVICE ON CREDIT CARD ORDERS,
CALL 1-(607)-843-2841
Fax: 1-(607)-843-6874
LEAVE MESSAGE, WITH PROJECT # AND/OR ORDER #,
ALONG WITH Visa and/or MasterCard CARD NUMBER.
ALL FUNDS MUST BE IN U.S. DOLLARS
We only accept Visa and/or Master Card Credit Card Orders
Name:_________________________________________ Address:_________________________________________ City:_______________ St:___ Zip:_____________ Phone #:_________________________________________
Please circle which applies: Check Money Order
If you are paying by Credit Card, please enter the Visa and/or MasterCard card number.
Don't forget to sign for it! Thanks. Include a $5.00 Shipping and Handling Charge
Card#:____________________________ Expiration Date________ Signature:_______________________________________
Please enter in the item numbers and/or order numbers, in the left-over spaces below:
Item
#__________ Description_____________________Price_________
Item #__________ Description _____________________Price________
Item #__________ Description _____________________Price________
Item #__________ Description _____________________Price________
Item #__________ Description _____________________Price________
____________________________________________Shipping________
_______________________________________________Total________
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