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Order Form - Print Version

You can safely enter your entire credit card number via our secure server, which encrypts all submitted information with a commerce-grade, 128-bit, key during transmission. This is the same security level used by banks and businesses around the world.

You may also print out this form and mail or fax your order with payment to:

Bubbling Spring Holistic Health Center, 9224 Manchester Road, Silver Spring, Maryland 20901-3341,

Fax: 301-587-1244.


* Name:
* Address:

* City:
* State:
* Zip:
Day Phone:
Evening Phone:
Fax Number:
* E-mail:

Note: Please press the "tab" key for your sub-total
to calculate.

Healing with Whole Foods $35.00
Aqueous Liver Extract $21.00
Cat's Claw $20.00
ReHydration $21.00
Shipping and Handling
(see below)

$20.00 to $34.00.........$5.40
$34.01 to $50.00.........$7.40
$50.01 to $75.00.........$8.40
$75.01 to $100.00.......$12.20
$100.01 to $150.00......$13.00
$150.01 and over........15% of order

UPS 2nd Day Air...add $20.00
UPS Next Day Air..add $35.00

MD Residents add 5% sales tax
* Total

 Method of Payment

Check (made payable to Bubbling Spring) Check Number
MasterCard  Visa 

Cardholder's Name

Account No.

Expiration Date:

Your order will not be complete until payment has been received. Please mark mailed order forms as COPY if faxing your order.

Please Fax your order to 301-587-1244

Questions?    Call us at 301-613-4449

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