The Happy Back: Fax/Mail Form

Your Purchases:

To complete your fax order: (1) Fill in all the fields on the form below. (2) Print the completed form. (3) Fax the completed form to the Happy Back. FAX: # (717) 691-6755.
You can also use US mail to submit your order to The Happy Back. Here's How.

Name
Email address
Street
Town/City
State
Zip Code
Country
Telephone
Credit Card details:
Name on Card Card Type Card Number Expiry Date

(1) Complete the order form. (2) Print. (3) Make your check payable to Dr. Michael J. Bartell for the full amount (NO C.O.D.s) of your purchase. (4) Mail your order and check to:

The Happy Back
c/o Bartell Chiropractic
1001 South Market Street
Mechanicsburg, PA 17055

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Copyright © 1998, Michael J. Bartell, DC
Web Page Design by: Sherrie M. Bartell, BA, MPA, PhD(c)

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