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To print order form, click your
mouse anywhere within the white area of the form and choose from the
option in your web browser, complete, then Fax
to 918-836-1308 or mail it with your
credit card info, check, or money order to Valhoma Corporation - 9925 E Admiral
Pl - Tulsa, OK
74116.
| Bill to name: |
Daytime Phone: |
| Address: |
Alternate Phone: |
| City: |
Fax: |
| State: |
Country: |
| Postal Zip: |
Email: |
Payment by (circle
one): Visa
MC
Check
MoneyOrder
COD |
| Credit Card # : |
Expiration Date: |
| Signature of card holder: |
| Ship to name (if
different than above): |
Daytime Phone: |
| Address: |
Alternate Phone: |
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| Item |
Price |
# of
Items |
| DMSO Liquid Pint 16oz. |
$10.95 |
: |
| Buy 2 or more DMSO Liquid Pint 16oz. |
$8.95 |
: |
| Buy a Case (12 Each) of DMSO Liquid Pint 16oz. |
$89.95 |
: |
| Buy 2 or more Cases (12 Each) of DMSO Liquid Pint 16oz. |
$79.95 |
: |
| DMSO Gel 1 lb. |
$19.95 |
: |
| Buy 2 or more DMSO Gel 1 lb. |
$15.95 |
: |
| Buy a Case (12 Each) of DMSO Gel 1 lb. |
$125.95 |
: |
| Buy 2 or more Cases (12 Each) of DMSO Gel 1 lb. |
$119.95 |
: |
| DMSO Gel 4 oz. |
$9.95 |
: |
| Buy 2 or more DMSO Gel 4 oz. |
$8.95 |
: |
| Buy a Case (12 Each) of DMSO Gel 4 oz. |
$89.95 |
: |
| Buy 2 or more Case (12 Each) of DMSO Gel 4 oz. |
$79.95 |
: |
| DMSO Liquid Gallon |
$69.95 |
: |
| Buy 2 or more DMSO Liquid Gallon |
$65.95 |
: |
| Buy a Case (4 Each) of DMSO Liquid Gallon |
$179.95 |
: |
| Buy 2 or more Cases (4 Each) of DMSO Liquid Gallon |
$169.95 |
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