Please print this form, fill it out, and mail it to:
Endless Forest Inc.
300 NE 12th Ave. Suite 601,
Hallandale Beach, FL 33009 U.S.A.

I want to order the following item:
EYE-MAX Magnetic Acupressure Eye Massager:
QUANTITY: US$19.95 EACH
EYE-MAX Shipping Price
QUANTITY S & H for U.S. S & H for Canada S & H for
outside U.S.
1 US$5.96 US$8.96 US$15.96
2 US$9.44 US$12.44 US$19.44
3 US$12.68 US$15.68 US$22.68
4 US$15.88 US$18.88 US$25.88

* Caluculate U.S. rate from Puerto Rico and U.S. Virgin Islands.
* Express Mail inside USA add US$15.
* Florida residents add 6% for state tax.

NAME________________________________________________________________

MAILING ADDRESS_____________________________________________________

CITY________________________________ STATE/PROVINCE_________________

ZIP/POST CODE_______________ COUNTRY_______________________________

PHONE _______________________________

EMAIL _______________________________

[  ] Check enclosed #___________

Source: WEB

Copyright © 1999-2005 Endless Forest, Inc., All rights reserved.

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