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Please print and complete this order form and send along with check or money order payments.
| Item |
Price |
Quantity |
Total |
| Take Control Of Your Back |
$12.95 |
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| Shipping (see main order page for charges) |
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| Grand Total |
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SHIP TO
| Name |
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| Address 1 |
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| Address 2 |
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| City |
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| State/Province etc |
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| Zip/Postcode |
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| Country |
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| Email Address |
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| You must provide an email address so we can send your membership password and user-id to you. We will also alert you when any new articles are added to the members section. Your email WILL NOT be used for any other purpose. Please print clearly. |
Send this form along with your payment to:
Visual Encounters Inc.
Backpain Help,
P.O. Box 1046
Hightstown, NJ 08520
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