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Wholesale Order Form

Order Date
Month
Day
Year
Payment Method
Credit Card (Visa, Master Card, American Express, Discover)
Money Order or Checks (Payable to My Safe Pass)
Bill on Account

Mail Checks or Money Orders to: 2438 47th Street Astoria, NY 11103

Seek medical attention if the test detects a loss of olfactory function. The absence of an abnormal test does not rule out that you have a disease or other conditions. Consult a healthcare professional, if you have symptoms of concern. The results do not consist of medical diagnosis and are not in place of a medical test of any kind.

TM

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