YOUR ACCOUNT IS OPEN - PLEASE SEND THE FOLLOWING:


PRODUCT CODE

NAME

QUANTITY

UNIT PRICE

TOTAL
32010 OPTHAL GEL 10 g $7.90
 
S&H SHIPPING AND HANDLING 1
$15.00
 

TOTAL
Minimum order quantity is 12 units


KINDLY FILL IN ALL INFORMATION REQUESTED

NAME OF DOCTOR/CLINIC:
ADDRESS:
CITY:
PROVINCE:
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*Tear Gel is a trademark of Alcon Pharma Inc.
Opthal Gel is a trademark of Stom Pharma Inc.