ENDLESSMEDS.NET

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ENDLESSMEDS.NET ORDER FORM

Email: sales@endlessmeds.net   "All Listings are One Time Fee Memberships and will be updated via our Password Protected Site"

Please make Checks or Money Orders (Fastest way) payable to: ENDLESSVISION ENTERPRISES

Send To:

Endlessvision Enterprises
P.O. Box 781
Hallstead, PA 18822-0781
 

Please send me the following List(s):

____Pharmacy List @ $29.99  Now only $24.99  Save $5.00! Access to our online member area for life! 

____Veterinary List @ $19.99  Now only $14.99  Save $5.00! Access to our online member area for life!

____Save $$$ Buy both the Pharmacy & Veterinary Lists @ $39.99 Now only $34.99 Save $5.00 Access to our online member area for life!

Total Amount enclosed: _____


*PAYMENT METHOD: ( ) CHECK ( ) MONEY ORDER  ( ) INTERNATIONAL MONEY ORDER   (Payable to a US Bank)

*NAME_______________________________________________________________________]

*ADDRESS____________________________________________________________________]

*CITY________________________] *STATE______________] *ZIP CODE________________]

HOME PHONE:__________________] WORK PHONE:_______________________]

***EMAIL (We will NOT sell or give it away) __________________________]

*User Name (6-32 characters, no symbols) wanted: ________________]

*Password (6-16 characters, no symbols) wanted:  ________________]

SPECIAL INSTRUCTIONS (Medications you are looking for etc...)__________________________]


 

 


 




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