Order

Broda O. Barnes M.D., Research Foundation Inc.
	Order Form
	"Health begins and ends with the proper balance of the endocrine system" Broda O. Barnes, M.D., Ph.D.

To contact us:

Broda O. Barnes, M.D. Research Foundation, Inc.

P.O. Box 110098
Trumbull, CT 06611

Phone: 203-261-2101
Fax: 203-261-3017

Please print, complete and return the form below to order any items on our catalog listing.

Check or Money Order, mail to: Barnes Foundation, PO Box 110098, Trumbull, CT 06611

Credit Card Orders, mail or fax: (203) 261-3017

Questions: (203) 261-2101

Name:_________________________________________________

Address:________________________________________________

City: __________________ State: ______

Postal Code:_____________

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Daytime Phone: ___________________

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3 items or more add shipping and handling of $4.00: $_________

International/Canadian Orders add $3.00 shipping: $_________

Total Dollar Amount of Order: $__________

Payment Method:

Check/Money Order Enclosed (made payable to Barnes Foundation) _____

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Expiration Date____________ Signature __________________________