Dear Med-Actil,
Please send my Mom (or other lady I love) a free Med-Actil product

Invoice me for one

to be shipped to this 

Please send my Mom a free 

to be shipped to her

I understand both packages will have free shipping. Please send my invoice to

Sign Mom up to our mailing list for great discounts and special offers!

We will include a note that says, "Happy Mother's Day from                        and your friends at Med-Actil" or another short and sweet message of your choice

I understand I must pay the invoice prior to the packages being shipped.

Thanks for submitting!