| New Medicine Press | New Medicine Press |
| 6137 E. Mescal Street | Mail Order Form |
| Scottsdale, Arizona 85254-5418 |
| Name: |
| Title: |
| Company Name: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Telephone: |
| Fax Number: |
| Email: |
| Credit Card (type, number, expiration) |
| Name on Credit Card, if different |
| Description | Quantity | Price |
| Total | ||
| Subtotal | ||
| Shipping and Handling (see details below) | + | |
| Sales Tax 8.1% (Arizona residents only) | + | |
| Total | ||
Shipping and Handling:
[Return to New Medicine Press order form]