CERBE Distribution Inc.
5270 Mills Street
Sherbrooke (Quebec) J1N 3B6 CANADA
Phone number: (819) 564-7883
Fax number: (819) 564-4668
ORDER FORM
(For the Sales Department)
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PERSONAL INFORMATION
Last name:   First name:
Address:      City:
State:          Country:    Zip code:
Phone:          Fax:     E-mail:
PROFESSIONAL MATERIAL AVAILABLE
PRICE
(US funds)
QUANTITY
TOTAL
HEALTH PRODUCTS

(1) 714X for perinodular injections (basic treatment)
       (1 cycle of 21 days - 2/6.5 ml vials)

(2) 714X mixture for inhalation (adjuvent treatment)
       (21 unidoses 2 ml ampoules / 3 boxes of 7 ampoules)

$450.00


$350.00












EDUCATIONAL MATERIAL
Book:
(3) The Galileo of the Microscope: The Life and Trials of Gaston Naessens
       (by Christopher Bird)
     Language: English French 


$20.00








Videotapes :
(4) History of 714X (Documentary and testimonials) - 1999 / 78min
     (not available in Dutch)
$10.00



(5) 714X : How does it work? How to administer the product
     (injection and inhalation) - 1999 / 48min
    (available in Dutch)
 $10.00

(6) Introduction to the Somatidian Orthobiology - 1999 / 91min
     (not available in Dutch)

Please indicate the VHS format for your region
     Format:     NTSC    PAL      SECAM MESECAM
     Language: English French  Dutch
 $25.00

DVD :
(7) History of 714X and how to administer - 1999 / 110min
     Language:     English French
20,00 $



Other:

Sub-Total:
Plus fees for shipping and handling*

Total cost:


SHIPPING AND HANDLING
Regular Mail : allow 6 - 10 working days
        (according to weight and destination)
Shipping address (if different from personal address):
PAYMENT MODE (All orders must be PREPAID and ARE NOT refundable. US funds only!)
VISA   MasterCard     Personal check1   Money order   Bank transfer

Card number:    Exp.:   /    Name on card: 
1 The order is sent 7 days after a personal check has cleared the bank.
   Credit card, certified check, money order and bank transfer: shipment is done upon receipt or authorization of credit.
COMMENTS