Please provide the information requested below for ordering through the mail and paying by check or money order. This form can be printed and mailed to:
CD Doctor, 925 Annway Drive, Sioux Falls, SD., 57103.
The form will print white. You should be able to type your information in and then print but hand written is OK. Payment can be made by check or money order. We no longer accept COD. All credit card orders need to be placed on-line. Click

Name
Street address
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
QTY DESCRIPTION Unit Price Total Price
Trauma Kit with 2 ounce GP & 1/2 ounce Acute.  $12.99
GP General Practice Repair in 4 ounce bottle $9.99
Protect in 4 ounce bottle $7.99

Sub Total

add your state sales tax: SD and California only.
add $4.00 S&H (USA) Priority
Order Total

Pay by check or money order only when sending this form.

Foreign shipping: check with your local postal service for rates from USA, 1 pound weight, or request rates from us prior to ordering. CD Doctor Home. Thank you for your order in advance.

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Only $4.00 shipping and handling per order no matter how much you purchase.



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