UreaSample.Com

Mail Order Form

Instructions:

Fill out the table below to look just like the checkout cart on our site, include a money order for the exact amount and mail to the address below. Please use all current prices for products and shipping. Current prices may be obtained from our website order page and shopping cart.

Send Order to:

848 N. Rainbow Blvd. #1192 Las Vegas NV 89107

Money Order:

Please make out to . You may purchase money orders at the post office and most convenience stores.

Qty	Product Number	Product (don’t forget to specify gender)	Total
		Shipping Method: 2-3 Days by 5:00 p.m. $14.95 Second Day by 5:00 p.m. $19.95 Next Afternoon by 3:00 p.m. $24.95 Overnight Express by 12:00 noon $29.95 International 2nd Day (Canada Only) $44.95 International 2nd Day (Outside U.S.) $54.95
		Total:
		Total Enclosed:

Shipping Info. :

Name Address Address 2 City State, ZIP Special Instructions Email

Thank you for your purchase!