YOUR ACCOUNT IS OPEN - PLEASE SEND THE FOLLOWING: PRODUCT CODE NAME QUANTITY UNIT PRICE TOTAL 31530 PURE-VU TOWELETTES (30/BOX) $7.15 31562 PURE-VU SOLUTION 100ml + 100 GAUZE PADS $8.65 31572 PURE-VU SOLUTION 100mL $7.65 TOTAL Shipping and Handling charge may apply. PLEASE SEND ME SAMPLES OF: PURE-VU SolutionPURE-VU Towelettes Promo Code: KINDLY FILL IN ALL INFORMATION REQUESTED NAME OF DOCTOR/CLINIC: ADDRESS: CITY: PROVINCE: POSTAL CODE: TEL: FAX: EMAIL: BUYER'S NAME: Δ