
| Name: _____________________________________ | Date: __________________ |
| Address: ___________________________________ | |
| City, St. Zip _______________________________ | |
| Phone: ____________________________________ |
|
Total merchandise $_______ Add $1.50 per item for Total due with order $_______ CARD NO. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __EXP. Date ___ / ___ X_____________________________Date___/____/____ P.O. Box 2410 * Gold Beach, OR 97444 |
Monthly Newsletter
Have a healthy day!


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