Handbook of
Antithrombotic Therapy
(4th edition)
by Thomas M. Hyers, M.D.
To order, mail or fax this form to:
Thomas M. Hyers, M.D.
C.A.R.E. Clinical Research
533 Couch Ave. Ste. 140
St. Louis, MO 63122
Phone: (314) 909-9779
Fax: (314) 909-9782
TERMS:
Please check Fed. Exp. or DHL and fill in your account number or credit card information for shipping costs. If using a personal credit card for shipment please supply your billing address at the bottom of the page as carriers will not deliver to an address different to that belonging to the holder of the credit card and bill the credit card.
Fed Exp Acct. # ______________________ or DHL Acct.. # _______________________
___*Check or **Credit Card: ___Visa ___MasterCard
(* Please make checks payable to Thomas M. Hyers, M.D. or C.A.R.E. Clinical Research)
Credit Card Number: ________________________________________________________
Expiration Date: ________________________________________________________
Name on Credit Card: ________________________________________________________
Signature: __________________________________________________
Please Print:
Name: ___________________________________________________________________
Address: ___________________________________________________________________
City: ____________________________ State: ____________ Zip: ___________
Phone: ___________________________________________________________________
Quantity: ___________ Cost * $____________
Missouri Sales Tax (if applicable) $____________
Total $___________
*If your institution is tax exempt, please fax a copy of the official tax exempt letter with your order.