NOTICE: We apologize but we are having problems with this order form.

Please call 1-800-683-0867 and we will be happy to take your order by phone.

UPS charges a $20 Department of Transportation (DOT) special handling fee PER PACKAGE, PLUS the ground shipping charges. We highly recommend that you combine an order with several other individuals local to you (you CAN NOT reship) to help share these shipping charges.

EMAIL PRODUCT ORDER FORM Due to DOT regulations, we can only ship H2O2 within the Continental United (48) States! Prices below INCLUDE the SHIPPING & $20 UPS FEE:
Retail QUARTS (32 oz)
	1 quart  @ $22.95 ea. = $22.95 + $27 s&h = $49.95
	2 quarts @ $22.95 ea. = $45.90 + $27 s&h = $72.90
	3 quarts @ $22.95 ea. = $68.85 + $27 s&h =$95.85
QUANTITY DISCOUNTS PINTS (16 oz) or QUARTS (32 oz)
	6 pints @ $10.45 ea. = $62.70 + $30 = $92.70
	12 pints @ $9.00 ea. = $108.00 + $30 =$138.00
	6 quarts @ $16.45 ea. = $98.70 + $30=$128.70
	12 quarts @ $13.25 ea. = $165.00 + $30 =$195.00
EMPTY PLASTIC DROPPER BOTTLE (1 oz size)
1 @ $1.50 = $1.50 2 @ $1.50 = $3.00 3 @ $1.50 = $4.50 1 @ $2.00 = $2.00 Shipping free with H2O2 shipment. If ordered separately, Add $2 s&h per order.
EMPTY PLASTIC DROPPER BOTTLE (1 oz size)
6 @ $1 = $6 12 @ $1 = $12 24 @ $1 = $24 48 @ $1 = $48 1 @ $3.00 = $3.00 Shipping free with H2O2 shipment. If ordered separately, Add $3 s&h per order.
First Name
Last Name
Company Name
Shipping Address
City
State
Zip Code
Mailing Address is same as above
Mailing Address
City
State
Zip Code
Credit Card Billing Address is same as Mailing address above
Credit Card Billing Address
City
State
Zip Code
Form of Payment: We Accept all 4 major credit cards If you prefer, to phone in your order call: 800-683-0867
Card Number
Expiration Date	01/00
Name as it appears on card
SHIPPING CHARGES are PER PKG. (this INCLUDES the UPS D.O.T. $20 special handling fee that is charged per package)

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