Order Form

Macular Degeneration Information Video

There is now an information video available on the microcurrent treatment for macular degeneration. The video is available for the nominal charge of ten dollars ($10), which includes shipping.

To order a video, send a check or money order (payable to the Acupuncture Center) and send to Gene Bruno, 1880 Lancaster Drive NE Suite 111, Salem, OR 97305. The video will be shipped within one business day of receiving your order. (We also can accept credit cards so call our office at (503 371-8770) to charge it.

Please send me _______ video @ $10/each

Total enclosed: $______________

Name _____________________________________________________

Address ____________________________________________________

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