OUTBACK MEDIC
SURVIVAL GEAR FOR SKIN®
.
www.outbackmedic.com

Click here to print out the order form. Fill it out and send it with payment to:
Outback Medic®, P.O. Box 822, Berlin, MD 21811 USA or Fax to: 410-629-0108

 
Please print clearly
 
Date  _______________________________________
Name  _______________________________________
Billing Address  _______________________________________
 _______________________________________
Shipping Address (if different)  _______________________________________
 _______________________________________
Day/Evening Phone  _______________________________________
Email Address  _______________________________________
How did you hear
about our company?
 _______________________________________
 
Credit Card Information
 
Credit Card Type    (   ) VISA  (   ) MasterCard  (   ) AmEx (   ) Discover
Credit Card Number  _______________________________________
Expiration Date  _______________________________________
CID Last 3 Digits on back

 _______________________________________

Name on Credit Card (print)  _______________________________________
Signature of Card Holder  _______________________________________
 
Outback Medic Survival Gear for Skin® Emu Oil Products
Prices Subject to Change Price Ea. Quantity Subtotal
Clear Relief® Doc's Glucosamine, Emu Oil & MSM (G.E.M.) Cream™ 4 oz $26.99    
Clear Relief® Doc's Glucosamine, Emu Oil & MSM (G.E.M.) Cream™ (2) - 4 oz $49.99    
Survival Gear for Skin® Pure Emu Oil (60 ml) $14.99    
Survival Gear for Skin® Pure Emu Oil (30 ml) $9.99    
LIP SAVER™ Lip Balm  $3.99    
Survival Gear for Skin® Moisturizing Lotion (60ml) $9.99    
Arthritis Reducing Plan™ Gelcaps $26.99    

 

Total  
Maryland Residents add 6% Sales Tax  
Domestic/US Shipping & Handling
For orders up to $35 add $4.95
For orders between $36 - $70 add $6.95
For orders between $71 - $100 add $8.95
For orders over $100 add 9%
(To calculate international shipping and handling
multiply domestic rates per dollar amount by 2)
Shipping  
Total  

Return to Ordering Info