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NAME: ______________________________________ EMAIL: ___________________________________________
STREET_________________________________________CITY_______________STATE____________ZIP_________
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ORDER FORM |
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Code |
Item |
Price |
Qty |
Total |
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1001-sr |
Small Reg. pad |
$ 2.00 |
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1002-sv |
Small VELCRO® brand hook pad |
$ 2.50 |
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1003-mr |
Med. Reg. pad |
$ 4.00 |
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1004-mv |
Med. VELCRO® brand hook pad |
$4.50 |
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1005-lr |
Large Reg. pad |
$ 5.00 |
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1006-lv |
Large VELCRO® brand hook pad |
$ 5.50 |
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1007-XL |
XL Night pad |
$ 6.00 |
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1008-pch |
W/proof Carrying Pouch |
$ 7.99 |
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1009-bkt |
Soaking bucket + lid |
$ 7.99 |
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1010-oxi |
Oxi-Clean 1-1/2 lbs. |
$ 6.99 |
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1011-3ds |
3-day supply Incl.15% discount |
$ 134.70 |
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1012-5ds |
5-day supply Incl.15% discount |
$ 199.30 |
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1013-1wk |
golden age- One-week supply(15% discount) |
$ 74.88 |
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1014-2wk |
golden age- Two-week supply(15% discount) |
$ 132.99 |
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INTERNATIONAL shipping out side USA please ADD an additional $10 to the regular shipping price |
$ 12.00 |
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Shipping+handelingTotal purchase: $15 to $75 = $11.95 Total purchase: $76 to $110 = $15.95 Total purchase: $111 to $150 = $18.95 Total purchase: $151 to $200 = $21.95 For every additional $40 OVER $200, there will be a $6 increase |
Subtotal |
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WA residence, Tax 8.4% |
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Shipping |
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Make check or money order Payable to: EMA PADSand mail to: EMA PADS, P.O.Box 201 McKenna, WA 98558 |
TOTAL(USD) |
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