Warning: Cannot modify header information - headers already sent by (output started at /home/medifocus/www/www/faxorderd.php:19) in /home/medifocus/www/www/faxorderd.php on line 57
Return to Guidebook Preview




MediFocus Guidebook on Scleroderma

Order by Fax: 1-301-649-7809


Print out and complete this Order Form
Guidebook Format: Electronic
Regular Price: $27.95 
Discount Coupon Code:SC926303397 
Your Discounted Price:$22.35 
Please provide your Contact Information:
We request your telephone number and/or E-mail Address in order to send you confirmation that your order has been processed.


 
Telephone Number:(________) ________-__________

E-mail Address:___________________________

Please provide your Billing Information:
  Check here if same as Shipping Address

First Name: ____________________   M.I.: ____   Last Name: ___________________________

Address: _______________________________________________________   Apt. # ________

City: _____________________   State/Province: _______________   Zip Code: ________

Please provide your Payment Information:
          

Credit Card Number __________________________________    Expiration Date ____/_____

Authorized Signature ________________________________

Print this Order Form and fax to:   1-301-649-7809

Order Fulfillment:

  • Printed Guidebooks are shipped the next business day by the Shipping Method you selected. Please allow 4 - 6 Business Days for delivery by U.S. Priority Mail or 2 - 3 weeks for delivery by International Air Mail.

  • We will contact you by E-mail or telephone and provide you with information on how you can access the electronic format of your Guidebook online, including free updates for 1 full year.
Questions About Your Order?

  • Please call us toll-free at 1-800-965-3002 or 301-649-9300
  • E-Mail us: info@medifocus.com

Return to Guidebook Preview