______   _

Last Name                    First Name                          MI

Address





Zip Code _ Phone (_)

Please charge my (circle one)

□ MasterCard    □ Visa

Card#__ Exp(mm/yy)

Security Code (last three digits on the back of the card)

Cardholder signature_ Date_

If paying by check, please make it payable to: Simpro Inc.

(Please include driver’s license number on the check)

*NatureSpirit***â Blood Pressure Monitor

KD-788 (1-10)        _ x $29 = $_____

KD-788 (11-20)      _ x $24 = $_____

KD-788 (21-100)    _ x $20 = $___

KD-788 (100up)      Please call for price

TX residents add 8.25% sale’s tax $_

                                                                 $_

Total Amount Due                                $_____

Please mail your order to:

Simpro Inc. 2018 Primrose Dr, Irving, TX 75063

Order by fax: 1-972-830-9987

www.naturespiritproduct.com

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