Mail Order Form (Please select
this form with your mouse before printing- upon request this form can be e-mail
to you if preferred)
mail
ComNur.com , 518 Massasoit Rd., Worcester, MA 01604 USA
Subtotal
Massachusetts
only) 5%
Sales Tax
Shipping
Total
MasterCard Visa Discover
American Express
Expiration Date
List last three #'s from back of card for,Matercard,Visa &
Discover___________________
List last 4 #'s above card # for American Express
Check Enclosed
Please note orders are not placed until checks clear
We add $30.00 handling charge for returned checks
Please keep a copy of this form for your records