MEDICULUM™ NYC by UMSNYC™

Your name: _________________________________________________________________

Shipping Address:

Street Address 1: ___________________________________________________________

Street Address 2: ___________________________________________________________

City: ___________________________________________________________

State: __________________

Zip Code: __________________

1 – 9 copies: $25.00 per copy	Qty: ___________________ Total: ___________________
10 – 49 copies: $23.00 per copy
50 – 99 copies: $21.00 per copy
(Shipping & Handling included)

Send with U.S. Money Order payable to Urban Medical Systems of NYC to:

UMSNYC

PO BOX 680086

CORONA, NY 11368

Thank you!

UMSNYC™

www.umsnyc.net