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Mag/Guaif Request

Mag Guaif Gel Request

I would like to order a tube of Mag/Guaif Muscle Tension Gel.

When it is ready:

Please call me, so I can come pick it up.

Mail it to me, below is my credit card information (I understand there will be a $2.00 shipping charge)

Credit card type:

Master Card Visa Discover

Expiration date:

My name is:

My address is:

My birthdate is:

The best phone # to reach me on during the day is:

I would like the following:

A 2oz tube for 42.00

A 4oz tube for 68.00

3349 Highway 31, Suite 102
Birmingham, AL 35209
Office 205-870-3150
Fax 205-870-3160
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