Order Form: Sore Nipples

Mail or Fax your order and make payment to:
Barbara Wilson-Clay
12710 Burson Drive
Manchaca, TX 78652

Fax: 512-292-7228

Voice: 512-292-7227
Email: bwc@lactnews.com

We accept: Visa/MasterCard, Personal Checks, Purchase Orders, and Money Orders
Our Tax ID number: EIN# 74-2923741

Name:___________________________________________________________________

Address (company):______________________________________________________

Address (street name & number):_________________________________________

Address (suite, room or dept):__________________________________________

City:____________________State:___________Zip:_______Country:___________

Phone: ________________________ E-Mail: ________________________________

Credit Card Type (Visa or MasterCard only):_____________________________

Credit Card # or Purchase Order Number:_________________________________

Credit Card Expiration Date:____________________________________________

Credit Card 3 digit security code on back:______________________________

Signature:______________________________________________________________

Number of Copies: __________________ at $15.00. Total: $________________
Discount: $13 a pad for 20 or more. $12 a pad for 100 or more.

Sales Tax: TX or PA only. Texas (8.25%), Pennsylvania (7%) _____________

U.S. Shipping and Handling:____________________
Shipping Cost: $6.00 for 1-3, $9.00 for 4-10, $12.00 for 11-20

Total Enclosed: $_______________________________________________________

Preferred shipping method: ____ UPS or ____ United States Postal Service

Please inquire concerning international shipping rates and bulk orders