www.UniversalExhalation.com

Order Form

Please print this form, complete it and mail it to us.

Name................................................................................
.........................................................................................
Mailing address.................................................................
.........................................................................................
City .................................................................................
State ............................... Zip .....................
Optional - In case we need to contact you:
Phone ............................................................................. 
Email ..............................................................................

 
If you buy: Price for the Package: Price for the Reminder™ Cling:
1 to 3 units $8.50 each $3.40 each
4 to 8 units $6.40 each $2.60 each
9 to 12 units $5.75 each $2.40 each
ITEM Quantity Unit prices Total
Shipping
total up to $25.00 $2.00
total up to $50.00 $3.00
greater than $50.00 $4.00
The card, Cling & gift envelope package   $  $
"Reminder™ Cling" sticker   $ $
       
Subtotal     $
Shipping      
Total     $

METHOD OF PAYMENT

□ Check enclosed payable to the "Page Hanes Company"
     for $.........................................

□ For Credit Card orders call 1-800-590-9131

Mail to:     Page Hanes 
                P.O. Box 55
                Saranac, MI 48881

 

Thank you for your order.