Aqua
Flora International Inc.
Date:____-____-____P.O. Box 666
Carroll, IA 51401 Please Circle One:
Name:_________________________________________________
Address:________________________________________________
Visa
MasterCard
Check
Money Order
City:_______________________________ ST:_______ Zip:________
|
ITEM |
AMOUNT # |
EACH |
SUBTOTAL |
| AQUA FLORA HIGH POTENCY |
$31.49 |
||
| AQUA FLORA PHASE I |
$25.04 |
||
| AQUA FLORA PHASE II |
$25.04 |
||
| AQUA FLORA HIGH POTENCY - 2 BOTTLES 5% OFF |
$59.84 |
||
| AQUA FLORA PHASE I - 2 BOTTLES 5% OFF |
$47.68 |
||
| AQUA FLORA PHASE II - 2 BOTTLES 5% OFF |
$47.68 |
||
| AQUA FLORA HIGH POTENCY - 4 BOTTLES 10% OFF |
$113.36 |
||
| AQUA FLORA PHASE I - 4 BOTTLES 10% OFF | $90.16 | ||
| AQUA FLORA PHASE II - 4 BOTTLES 10% OFF | $90.16 | ||
| THREE-PHASED PROGRAM 2 BOTTLES OF EACH 15%OFF |
$138.67
|
||
| SUBTOTAL | |||
| FREIGHT: PRIORITY MAIL | FREIGHT | ||
| 1 BOTTLE-$5.00 2 BOTTLES-$8.00 3-9 BOTTLES-$9.00 | TOTAL | ||