COUPON


Medication Usage Evaluation 3rd Edition

Order Online and Save $20
or
Print and Send Order by Mail or Fax

Your Choice of Order Forms
(link opens new browser or Reader window)

HTML Form
Adobe PDF Form

Online Ordering Below
(SSL Secure Server)


*Required Information

*First Name     *Last Name

Title

Organization     Department

* Street Address

*City   *State   * Zip

*Phone Number   Phone Ext.

Fax Number

*E-Mail Address (required for e-mail confirmation of order)



  Qty Cost Totals
MUE Manual plus CD-ROM
(Includes MUE Primer and MUE 2002 Quarterly Updates)
ORDER ONLINE & SAVE $20 With Free Shipping
x $149.95 $
MUE Primer Only (shipping included) x $29.95 $
MUE Updates Only (shipping included) x $79.95 $

Total $



Payment Options

Purchase Order *   Check*
Purchase Order No.
Check No.

*Items will be shipped when payment is received by mail, or copy of purchase
order is received via mail or fax (757)625-4538.
(Please print a copy of this page for your records)

© 2002 Insight Therapeutics, LLC
All Rights Reserved