Splintex by Horse Systems Inc.

(800) 535-6642 hrsysinc@together.net

Since 1980
Producers of Splintex, The Recommended Treatment For Splints

ORDER FORM

SHIP TO:

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ADDRESS:	____________________________________________________________
	____________________________________________________________
CITY:	____________________________________________________________
STATE:	_______________________________ Country: ____________________
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ORDER:

ITEM	PRICE	QUANTITY	TOTAL
Splintex Gold (60 ml)	$44.50 per unit	___________	____________
Splintex Silver (30 ml)	$39.50 per unit	___________	____________
		Shipping:	____________
		Vermont Sales Tax:	____________
		Total:	____________

Please add for Shipping:US $5.00 per order in the US and Canada, $12.00 for 1-2 units and $2 for each additional unit for foreign orders

Vermont residents, please add 5% sales tax

METHOD OF PAYMENT:

Check/Money Order Visa Mastercard American Express Discover
Make Check/Money Order Payable to Horse Systems, Inc.

For credit card payments, please complete the following:

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THANK YOU FOR YOUR ORDER