Stamina-Rx       

Order Form

To order by check, cashiers check, or money order

Please make checks payable to "Pinnacle." Print this page and mail to:

Pinnacle

Attn: Ed Hodges, Customer Service

2300 McCue Road, No. 370

Houston, Texas  77056

Item                                                 Quantity                      Price, $        Amount

Stamina-Rx 10 tablets                                                35.00                                   

Stamina-Rx 20 tablets                                                60.00                                   

Stamina-Rx 30 tablets                                                90.00                                   

Shipping & Handling                                                  3.00                                   

Overnight Shipping by FedEx                                       9.00                                

TOTAL                                                                                                                  

----------------------------------------------------------------------------------------------------

Guaranteed delivery shipped to:

Name _____________________________________________________________________________

Address ___________________________________________________________________________

City _______________________________________ State ______________ Zip ________________

email address ___________________________________ Phone _____________________________

Special Instructions: _________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________