| GOUTWELL.COM Mail Order Form (You can complete the form and print out) |
| Product Code: ITP-kit (1 Blood-well + 2 Restore Immune II) |
| Please make checks or money orders payable to: Fuma Natural |
| Quantity |
Cost |
Shipping + Handling |
Total |
| 1 |
$119.95 |
$7.50 |
$127.45 |
| 2 |
$225.00 |
$7.50 |
$232.50 |
| 3 |
$305.75 |
$7.50 |
$313.25 |
| 4 |
$407.60 |
$7.50 |
$415.10 |
| 5 |
$510.00 |
$7.50 |
$517.50 |
| Mail this form with your payments to: Goutwell.com/ Fuma Natural 12881 Knott Ave. Suite #113 Garden Grove, CA 92841 |
| California residents, please add 8.25% sale tax. For outside USA orders, please add $29.95 (instead of $7.50) for Shipping and Handling cost. |
| Thank you for your order. Please print out this form and mail with your payments. |
| Copyright © 2004 Goutwell.com/Fuma Natural - All Right Reserved. - 12881 Knott Ave., Ste 113, Garden Grove, CA 92841 |