Order form for: Lipoprint® - A Breakthrough in Cholesterol Management. Price: $24.95

For fax orders, please print, fill out and fax to: 800.845.1834

For postal orders, please print, fill out and mail to:

Quantimetrix Corporation, Dr. Robert W. Ban
2005 Manhattan Beach Boulevard, Redondo Beach
CA 90278, USA



Name ____________________________________________________________
Address __________________________________________________________
City _______________________________ State ______ Zip ________________
Telephone ________________________________________________________
Email ____________________________________________________________
Sales tax: Please add 8.5% for products shipped to California addresses
Shipping Cost by air: U.S. $8.00 for first book and $4.00 for each additional book. International $9.00 for first book; $5.00 for each additional book (estimate).
Payment: __ Check   __ Credit Card (please check type): __ Visa   __MasterCard
Card Number ____________________________________ Exp. Date _________
Name on Card _____________________________________________________
Signature _________________________________________________________

 

Once the order is received, we will contact you to confirm the order. If you have any questions, please email: monica@4qc or call 310.536.0006

Thank You for your order!