CHOLESTEROL CONTROL ORDER FORM
| Description | No. | Total |
|
Chemcard Test Kit (contains 2 tests and 2 lancets), $19.00 If more than 9, see the Discounts page. |
$ | |
| Package of 2 extra lancets, $1.00 (not counted as a foreign postage "item.") | $ |
| Postage to countries outside the US. Add $11. Includes insurance. | $ |
| Total. | $ |
| Name: |
| Address 1: |
| Address 2: |
| City: |
| State (if used): |
| Postal Code: |
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| Email (will be kept private): |
| Telephone (will be kept private): |
| Date: |