Subtotal p1, plus subtotal p2, plus subtotal p3
________________
Shipping and Handling
________________
Subtotal plus Shipping and Handling
________________
(Contact us for Additional International Postage)
Sales tax LA 8.5 %
________________
TOTAL DUE
________________
Purchase Order Number _________________(attach
authorization)
Check Number___________________(payable to Timely
Neuropathy Testing)
Shipping and Handling (For orders less the $50. add $5.00,
for orders more than $50. add 10 percent (for orders outside continental US
contact us for shipping and handling)
BILL TO SHIP TO (if
different from billing address)
Name_____________________________
Name___________________________
Company__________________________
Company_________________________
Address___________________________
Address__________________________
City_____________State____ZIP______
City____________State____ZIP______
Phone Number_____________________ Phone
Number_____________________
Email_______________________________
THANKS FOR YOUR ORDER!
(for internal use
Received________________ Process Date_____________________)
