Family Doctor II Mail or Fax Order Form - Fax 1.866.854.2342
Payment:
Please submit card information if Paid by Mail:
Card Holder's Name:
Expiry Date:
Name
Address
City/Town
Province
Postal Code
Day Phone No.
Evening Phone No.
E-mail Address
How did you find out about the FDII?
Purchase Family Doctor II:
Additional Accesories:
Shipping:
Tax:
Total: Shipping & Applicable tax will be added to your card
Delivery Time:
7-12 business days
Send to:
FAMILY DOCTOR II, 122-B 1st Street NE, Dauphin, Manitoba, Canada, R7N 1B5
Fax Order Form - Fax 1.866.854.2342