ORDER FORM

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30 day guarentee

          Name:       
       Address:

City: State: Zip:

E-Mail:

      ITEM 1:     ITEM 2:
    QUANTITY:                QUANTITY:
 TOTAL PRICE:         TOTAL PRICE:
TOTAL WEIGHT:        TOTAL WEIGHT:

      ITEM 3:     ITEM 4:
    QUANTITY:                QUANTITY:
 TOTAL PRICE:         TOTAL PRICE:
TOTAL WEIGHT:        TOTAL WEIGHT:

      ITEM 5:     ITEM 6:
    QUANTITY:                QUANTITY:
 TOTAL PRICE:         TOTAL PRICE:
TOTAL WEIGHT:        TOTAL WEIGHT:

      ITEM 7:     ITEM 8:
    QUANTITY:                QUANTITY:
 TOTAL PRICE:         TOTAL PRICE:
TOTAL WEIGHT:        TOTAL WEIGHT:

                  SUB TOTAL $:
 ARIZONA RESIDENTS ADD 5% TAX:
                 TOTAL WEIGHT:

ADD $5.95 FOR FIRST 2 LB SHIPPING, $1.50 FOR EACH ADDITIONAL LB

                   SHIPPING $:
                      TOTAL $:

CreditCard #:

Expiration Date:

VISA MASTER CARD

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