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Chin-Up StripsŪ   -   Retail - Volume Discount Prices    -    12/01/08
The Chin-Up Company
Dale Miller, Inc.
1820 Ridgemill Terrace
Dacula, GA 30019
www.chinupstrip.com
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Call: 1-888-835-4563
In Atlanta: 678-482-8507
Fax: 678-482-8509

ALL shipping with tracking

To Order Online: CLICK "Order Online" above DATE:_____________________
 NAME: _______________________________________________________________________
 ADDRESS: _______________________________________________________________________
 CITY: __________________________________ STATE: _______ ZIP: _______________
 EMAIL: _____________________________________ PHONE#: ____________________
 SEND BROCHURES?   ___YES      HOW MANY _______ P.O.#: ____________________
 
Chin-Up Strip Type: Quantity: Price US-S/H Subtotal
  ___ WHITE Horseshoe (#11130)
      _____ 30ct. Packs $14.99 Free/mail $__________
  ___ TAN Horseshoe (#22230)
      _____ 30ct. Packs $14.99 Free/mail $__________
  ___ TAN Boomerang (#33330)
      _____ 30ct. Packs $14.99 Free/mail $__________
  ___ 1 - 500ct. Tan Horseshoe Roll (Shipped UPS Ground) $145.00 $10.50 $__________
  ___ 1 - 500ct. Tan Boomerang Roll (Shipped UPS Ground) $145.00 $10.50 $__________
  ___ 1 - 500ct. White Horseshoe Bulk Pack (Shipped UPS Ground) $145.00 $10.50 $__________
Breathe Right Nasal Strips Type:

Quantity:

Price US-S/H Subtotal
 ___ Large Tan Strips       _____ 38ct. Packs $15.99 Free/mail $__________
 ___ SM/Med Clear Strips       _____ 38ct. Packs $15.99 Free/mail $__________
ReliaMed Quantity: Price US-S/H Subtotal
 ___ Adhesive Remover Wipes       _____ 50ct. Packs $12.99 Free/mail $__________
 ___ Skin Protective Barrier Wipes       _____ 50ct. Packs $12.99 Free/mail $__________
* * * Email customer service for shipping cost outside US 48 states    $__________
GA Residents Only - Sales Tax @ 6.0%    $__________
Send Check or use Credit Card - TOTAL    $__________
 
Credit Card #_____________________________________________________________________
Card Type:   ____ Visa   ____ MasterCard   ____ AmEx    ____ Discover     Exp. Date: _____________
Name on Card:____________________________________________________________________