Mail In Order Form

1. Complete and print this form, or print a blank form for a friend! 2. Mail the completed form with your Check or Money Order to: Miss Patty's, Inc. , P.O. Box 361723, Melbourne, FL. 32936-1723 Place an "X " in the box next to the quantity & grade you want to order.

CHOOSE: Land Grade Or Marine Grade

	1 Bottle $8.66 + $2.50 S&H =	$11.16
	2 Bottles $15.98 + $4.95 S&H =	$20.93
	3 Bottles $23.97 + $4.95 S&H =	$28.92
	4 Bottles $31.96 + $4.95 S&H =	$36.91
	12 Bottles $95.88 + $13.95 S&H =	$109.83
	24 Bottles $191.76 + $13.95 S&H =	$205.71

All orders come with a FREE pH test kit
(Shipping to USA only)

First Name:
Last Name:
Address:
Address:
City:
State:
Zip Code:
Home Phone:
E-mail:

THANK YOU FOR YOUR ORDER Orders paid with Business or Personal checks will be held for 7-10 days for check to clear. Orders paid with Money Order will be shipped within two business days. just-calcium.com

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Copyright ©2004, Miss Patty's, Inc.