Geodesic MediTech
On-Line Order Form

• Please allow 7 working days for your order to be shipped.
• All orders are held in strict confidentiality and will be mailed in discreet plain envelopes.
• The information from this form will be sent to [email protected].
• You also have the option to print out the form and FAX it to: 001 (619) 793-1824.
• You may order over the telephone at 001 (619) 792-1100 or TOLL-FREE in the U.S. at 1 (888) 357-9399.

Product                                Unit Price          Quantity Desired
OvuSign
     (5-Day Ovulation Pred. Kit)       US$21.95            
          5 cups, 5 test devices & pipettes, instructions
OvuSign Mid-Stream
     (5-Day Ovulation Pred. Kit)       US$24.95            
          5 test devices, instructions
     each additional Single 
     Mid-Stream Test                   US$ 3.99            
     [limit 10 per kit ordered]    
LifeSign
         One Pregnancy Test            US$ 9.95            
          1 test device, instructions
         Two Pregnancy Tests           US$13.95            
          2 test devices, instructions
Postage (domestic and international) and sales tax (US only)
are included in the above prices.

SHIP TO:
Name:    
Address: 
City:    State:Zip Code:
Country: 
Home Telephone:     (optional)
International orders please include country code.
E-mail Address:     

Payment Methods:

Credit Card (VISA/MC) (Products usually mailed the same day.),
Check, or
Money Order
Credit Card Number: Expires:

Signature(if FAXing information): _______________________________________

Please mail Check or Money Orders in advance and made payable to(products mailed upon receipt):
GEODESIC MEDITECH
1155 Camino Del Mar, #517
Del Mar, CA 92014 USA