Secure ShoppingEARinc.com Specialized Hearing Systems:
Health Supplements Order Form
Client Information
   
Client Name
Ship to:
Name
Address
City/State/Zip   
Country
Contact
Phone
   
Product Information
  
RingStop
Introductory Package (4 Bottles) - $90.00
Single Bottle (60 Caps) - $30.00
Two or more Bottles - $25.00/each
  
RingStop Ear Drops
1 bottle - $17.00
2 bottles - $32.50
3 bottles - $46.50
  
OptiAll
Introductory Package (4 Bottles) - $75.00
Single Bottle (60 Caps) - $25.00
Two or more Bottles - $22.00/each
  
HearAll
Introductory Package (4 Bottles) - $90.00
Single Bottle (60 Caps) - $30.00
Two or more Bottles - $25.00/each
  
Special Instructions
 
If you have any special instructions, please explain in the space provided:
   
     
Payment Method
 
Personal Check Company Check Visa MasterCard
Account Name
Account Number  Exp. Date / CCV
  All orders will be sent UPS Ground unless specified above. Foreign countries, please contact us before ordering.
   

To submit an order, fill out this form, print it, and then either fax it, or mail it to:

E.A.R. Inc./Insta-Mold West
P.O. Box 18888
Boulder, CO 80308 USA

Phone: (303) 447-2619
Toll-free: (800) 525-2690
Fax: (303) 447-2637

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