PLEASE PRINT THIS FORM
MAIL ALL ORDER FORMS TO:Cheap-Scrubs.com44 Cedar Avenue.Charlottetown, PEI. C1A 6K4 Canada
FOR ADDITIONAL INFORMATION EMAIL: help@cheap-scrubs.comYou may fax your order to: (480) 247-5081
STYLE NUMBER
COLOR
SIZE
QTY.
DESCRIPTION
PRICE EACH
TOTAL
NAME:
ADDRESS:
FORM OF PAYMENT
Expiration Date:_____________
Total Amount For Goods
TAX
Shipping
$12.99
TOTAL AMOUNT
Card Number:_______________________
You may also a Money OrderFor your protection, do not send cash. We do not accept C.O.D.s
