TheraCuppingtm Health & Beauty Care
TheraCupping, LLC
P.O. Box 1266
Asheville, NC
United States
Order Form
CREDIT CARD INFORMATION
Name________________________________________________________
Billing Address____ ____________________________________________
Shipping Address___________________________________________
Telephone__________________ ___________________________________
Credit Card Number____________________________________________
Expiration___________________ CVV Code _____________
SIGNATURE _______________________________________
ITEM DESCRIPTION PRICE QTY TOTAL
Glass vacuum set of four cups $35.00 ____ _______ German hand-blown glass set of five $85.00 ____ _______ Russian Silicone Cups set of three $59.95 ____ _______ Pistol and connecting tube set $20.00 ____ _______ Face Lifting & Drainage & Scar Care Kit $42.00 ____ _______ Magnetic micro-cup set of 8 $55.00 ____ _______ HACI manual (free with magnet set!) $7.50 ____ _______ VacuLifter B1 __ B2 __ F1 __ F2 __ $75.00 ea ____ _______
Subtotal $________ Please fax completed form to
Sales Tax $________ TheraCupping, LLC at
Shipping $__8.95___ 216-941-7679
Total $________
TheraCupping, LLC
P.O. Box 1266
Asheville, NC
United States
