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THIS ORDER FORM FOR MAILING OR FAXING 248-706-2099
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BackPro-CPMTM: $1,995.00
+ S&H $69.00 = $2,064.00 Michigan Residents
add 6% Sales Tax to product
cost. Please indicate you choice of payment:
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Expiration date: _______
Email Address:__________________________________________________
Name:_________________________________________________________
Address_______________________________________________________
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ZIP:___________________________________________________ Telephone:___________________________________________
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