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MediFocus Guidebook on Polycystic Kidney Disease
Order by Fax: 1-301-649-7809
Print out and complete this Order Form
Guidebook Format:
Printed
Regular Price:
$39.95
Discount Coupon Code:
PK841933418
Your Discounted Price:
$29.95
Shipping & Handling -
Please select your Shipping Method preference:
Shipping Method
Cost
Estimated Delivery Time
United States (U.S. Priority Mail)
$4.95
3-5 Business Days
Canada (International Air Mail)
$29.95
1-2 Weeks
Please provide the Recipient's Shipping Address:
First Name: ____________________ M.I.: ____ Last Name: ___________________________
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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/Territory: _______________ 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
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