betterairways.com
3340 Chatsworth Lane
Orlando, FL  32812
(877) 414-4449 • Fax (407)888-2795

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Print out this form and fax it to
407-888-2795 to send your order.

Betterairways.com gladly accepts Master Card and Visa.
Your charges will be processed by PN Medical.

Name:
 
Address:
 
Address 2:
 
City, State & Zip
 
Phone (Daytime):
 
Credit Card Number
       
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-
       
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Expiration Date:
______/______ Security Code __ __ __
Product
Description
Quan
Price
Total
Breather
for COPD
x
$24.95=
for Asthma
x
$24.95=
for Smoking Cessation
x
$24.95=
Shipping Charge Shipping & Handling
$ - $ 20.00 @ ............$ 4.50
21.00 - 35.00 @........... 5.00
36.00 - 50.00 @........... 5.50
51.00 - 75.00 @........... 6.50
76.00 - 100.00 @ ......... 7.50
Over - 101.00 @........... 9.50
Florida residents, please add 6% sales tax.
Total for this Order

For any questions or comments concerning your order, or if you
experience any difficulties, please email us.