Merry Clinic MAIL/FAX Order Form

To place an order, please print this page and fax or mail your order.Click here for our policy.Use your BACK button to access the previous page.

Tel: 888-880-1499 (inside US/Canada)  or 650-588-8335   Fax: 650-588-2544
MAIL Address: Merry Clinic,  370 San Bruno Ave West, Suite F, San Bruno, CA 94066

Sold To: (If paying by credit card, note your name and address as it appears on file with your credit card company.)

Name:_________________________________
Address:______________________________
____________________________________
City:_________________________________
State: ______   Zip: ________________
Daytime Phone: ______________________
Email: _______________________________

Ship To: Please fill in information below if  the shipped to address is different.

Name: _____________________________
Address:____________________________
__________________________________
City:_____________________________
State: _____  Zip: _________________
Country: _______________

Daytime Phone: ___________________

 ITEMS ORDERED:
Item Name Qty Price Each Total Price
       
       
       
       
       

METHOD OF PAYMENT

o Money Order (Payable to Merry Clinic. No Cash or Personal Check)
oAmerican Express    oMastercard     oVisa      oDiscover

Credit Card Number  :____________________

Name On Card  :____________________
Expiration Date  :________________________
Signature : ____________________________

Merchandise Subtotal
State Sales Tax (California only)
(See Box "A" below)
 
Standard Shipping & Handling
(See box "B" below)
 
TOTAL
A: STATE SALES TAX INFORMATION:
We are required by law to collect sales tax on shipments to the state of California. Our Tax rate is 8.25%.

B:     STANDARD SHIPPING 

Delivery Location

Shipping Cost
US  $8.95
Canada  $20.00
Other Country  $45.00
  2016 Merry Clinic.