New type-in printer-friendly version!

 

DermaSoothe (TM)

Order Form

 

New! East-West Clinic now takes orders with your VISA or Master Card .
You can order by calling the East West Clinic:
Toll-free number: 1-877-401-4757 or call (651) 429-9595.
  For mailing orders, send a check or money order payable to the East West Clinic, or mail your credit card information, along with the form to:
East West Clinic, 5770 W. Bald Eagle Blvd., White Bear Lake, MN 55110.

If you want to order by fax, please fax this form with your credit card information to: (651) 429-9595.

You may contact the East West Clinic with questions about these products at (651) 429-9595.

Name:   
Address:  
City/State/Zip:  
Area Code/Phone#:  
Quantity of 4 oz bottle ordered: $15.00 US  x =  $
Total Order:   
Shipping and handling will be added to your bill.


If paying with a credit card, please fill this section:

Name: 
Credit card (check one):   VISA  MasterCard  
Credit card number:    
Expiration date:

Call 651-429-9595 for shipping charges outside the US. Please do not send cash through the mail.


Contact Us


5770 W. Bald Eagle Blvd., White Bear Lake, MN 55110
Tel./Fax: (651) 429-9595


E-mail East-West Clinic


© 1997 - 2004 East-West Clinic. All rights reserved.
Last Updated November 25, 2004