(813) 922-8939 | info@flalternativemeds.com

Usanitize Order Form

Order

Hand Sanitizer Order Form

Product *
Enter your full name
Shipping Address *
Shipping Address
City
State/Province
Zip/Postal
Do you have different billing address? *
Billing Address *
Billing Address
City
State/Province
Zip/Postal
Credit Card Authorization Form
Credit Card Type *
This is the number from the back of your card.
Draw your E-Signature.

You are authorizing Florida Alternative Medicine to charge and sign your card for this transaction only using SQUARE.

*Florida Alternative Medicine reserves the right to have NO RETURN and NO REFUND policy.