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"Relief is Everything"
P.O. Box 691475
Charlotte, NC 28227-7025
1-888-368-3902

Call toll free 1-888-368-3902 to place your order 7
days a week, 24 hours a day or fill out the form below.

 

Billing Address:


Name: _________________________________________________________

Address: _______________________________________________________

City: ___________________________________ State: ______ Zip: ______

Shipping Address:

Name: _________________________________________________________

Address: _______________________________________________________

City: ___________________________________ State: ______ Zip: ______

__ 4 oz MaXXiRub @ $29.95 plus $6.95 S/H                  ________________

MaXXiRub Specials

__ 2 - 4oz MaXXiRub for $49.95 plus $6.95 S/H            ________________
__ 6 - 4oz MaXXiRub for $139.95 plus $10.95 S/H        ________________

NC Residents add 6% sales tax                                       ________________

International Shipping Rates Apply              Total:      ________________

Credit Card Information

Credit Card (circle) Visa     MasterCard     Discover     Card Number: ___________________________________

Credit Card Expiration Date: ________________ (MM/YY)

Money Orders made payable to Queen of Hearts, Inc.