Order: from: The Cloonan Corporation
I would like to purchase _______ pack of 2 x 16 ounces bottles of The Answer ®
for the price of $30.00 each Total $ ___________
(Plus S & H)).
Send to:
Name: ___________________________________________
Address: _______________________________________________
City / State / Zip: _________________________________________, U.S.A.
Personal Friend Caregiver Facility Trial
Payment Info:
I authorise The Cloonan Corporation to charge my Credit Card for the purchase of
The Answer ® plus shipping and handling. Today's date: ____________
Visa M.C. AX Other: ______
Account number: _________________________________________
Expiration date (mm/yy): _____/______ 3 digit code: _________
Name as on card (print): ___________________________________________________
Signature: ________________________ Phone Number:______________________
I would like to arrange repeat shipping of The Answer ®
Every: 2 weeks Month 2 months Other __________
Please bill my Credit Card account for every shipment sent.
(Repeat shipments can be cancelled at any time by phone or by fax)
Signature for repeat shipments: ____________________________
Questions or comments:_________________________________________________
_________________________________________________________________
The Cloonan Corporation 1440 Grand Avenue, Suite D San Marcos, CA 92078
Phone (760) 891-0093 www.theanswer2oralcare.com
FAX to: (760) 891-0084
