Printable Order Form - Furshpan Chiropractic Educational Series chiropractic educational posters muppets jellybeans chiropractic care is a family affair spinal decay spinasaurus spinosaurus chirosaurus nervous system subluxations get on your nerves i'm feeling fine when my spine's in line spinesmart spine smart spinesmarts spine smarts xrays x-rays xray series bernard furshpan bernie furshpan

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Print Order Form

Phone
1.631.665.1235

Fax
1.631.665.1102

Mail
Furshpan, D.C.
1150 Sunrise Hwy.
Bay Shore, NY 11706

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.....EDUCATIONAL POSTERS 24" X 36"1
01

.....EDUCATIONAL POSTERS 18" X 24" ---------------------- HOLOGRAM 8" TALL1
05

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.....SPINESMARTS VIEWBOX X-RAYS 14" X 17"
19

NEW! ONLINE
C.A. TRAINING PROGRAM
www.chiropracticassistant101.com

chiropractic educational posters muppets jellybeans chiropractic care is a family affair spinal decay spinasaurus spinosaurus chirosaurus nervous system subluxations get on your nerves i'm feeling fine when my spine's in line spinesmart spine smart spinesmarts spine smarts xrays x-rays xray series bernard furshpan bernie furshpan

Subtotal	$0000000
NY Sales Tax	$
S&H	$ 10.00
2nd Day Air	$ 15.00
TOTAL DUE	$

Name____________________________ Date___________
Office Name______________________________________
Address_________________________________________
City______________________ State_____ Zip_________
Phone ( ) __________________________________

Item #	1	2	3	4	5	6	7	8	9	10	12	13	14	15	16	17	18
Qty.	.	.	.	.	.	.	.	.	.	.	.	.	.	.	.	.	.
Price	30.	30.	30.	30.	25.	25.	25.	299.	25.	25.	25.	25.	25.	25.	25.	25.	25.
Total	.	.	.	.	.	.	.	.	.	.	.	.	.	.	.	.	.

Payment Method:
[ ] Check to: Furshpan, D.C. [ ] MC [ ] Visa [ ] Amex
Credit Card # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Name _______________________________________________
Exp. Date ____ / ____ Sign ____________________________
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