Authorization Letter DADDY

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GERONCIO B.

PURISIMA
135 Linmansangan,
Binalonan,Pangasinan

MERCURY DRUG
Binalonan Branch
Binalonan, Pangasinan

AUTHORIZATION LETTER FOR PURCHASE OF MEDICINE

This letter is to authorize the bearer of this letter to purchase my medicine in my name because I
can’t personally purchase my medicine due to my physical restrictions (Stroke Patient). Thank you
for your kind consideration.

Sincerely,

GERONCIO B. PURISIMA
Senior Citizen Customer

Senior Citizen ID Information:


Control Number: 795
Address: Linmansangan, Binalonan, Pangasinan
Birthday: 05-09-1940
Gender: Male
Date Issued: 02-28-2006

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