Wolff Drug & Gift Mail Order Form

Please USE THE PRINT OPTION of your Web Browser to copy this page.  To place an order, complete this order form.
You may charge your order to your MasterCard or Visa or by making a check or money order to Wolff Drug and mail to:
Wolff Drug, P.O. Box 188, Pierz, MN  56364.
You may also place your order by telephone at (320)468-6482 or by sending via fax to (320)468-0041.             

Name __________________________________________________Phone Number ___________________________   

Address _______________________________________ 

City/State/Zip ___________________________________(    ) Is this a CHANGE OF ADDRESS?

          Shipping and Handling:    $0.00 to $20.00  -  $4.50
                                                     $20.01 to $40.00  -  $5.50
                                                      Over $40.00  -  $6.50      
          *NOTE:  Orders shipped outside the continental United States may have additional shipping charges                
                                                      

Method of Payment (Check One)
                  Check or Money Order (US Funds Only)  ___ Visa___ Mastercard ___

Account Number:  |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Expiration Date: __________                    Signature :  ______________________________

Prices may change without notice - Please allow 7 to 10 days for delivery

Comments or further instructions: