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     Order Form

Instructions:
Mail your order request to: AzVMA, 100 W. Coolidge St., Phoenix, AZ 85013.  Fax: 602-249-3828


Back to Member Benefits

 

# of Packs

Price

Brochure Name

Total
  $10.00 per pkg of 50 WHAT YOU SHOULD KNOW ABOUT  $
  $10.00 per pkg of 50 CANINE EHRLICHIOSIS $
  $10.00 per pkg of 50 VALLEY FEVER $
 

$10.00 per pkg of 50

CARING FOR OUR BEST FRIENDS               

 $
 

$10.00 per pkg of 50

CANCER IN ANIMALS

 $
   

                                                                                Subtotal

 $
   

Postage & Handling

 $
   

                                                                                 TOTAL

 $

 

Postage and Handling
Quantity

Add
1 pack $4.00
2 packs $6.50
3 packs $7.00
4 packs $7.50
5 packs $8.50
6 + packs

  We will contact you with the
  total cost for postage or 
  arrange for pick up.

 

Veterinarian:
Hospital/Clinic Name:
Address:
City: State:   Zip:
Phone: Fax:

___ Please send me an invoice with my order.     
___ I have enclosed a check for the amount of: $_______
___ Please bill my credit card in the amount of: $_______

Credit card #: ________________________________________________________________

Exp. Date: ______________ Vcode: __ __ __  Billing zip: ______________________________

Print name on card: ____________________________________________________________

Signature: ___________________________________________________________________