Mare Magic Order Form

MARE MAGIC -- ORDER FORM

Name

Address

City, State & Zip

Phone

Work Phone

E-mail

Type of Credit Card

VISA MasterCard Discover AMEX

CC#

Exp Date/ Security Code

Signature _____________________________________________________________

Circle the sizes that you wish to purchase	PRICE --	$66.95 Value-Pak (32 oz)
SHIPPING --		$ 7.00
Order TOTAL --		$73.95

PRICE --	$18.00 (1 bag)	$36.00 (2 bags)	$54.00 (3 bags)
SHIPPING --	$ 4.00 (1 bag)	$ 5.00 (2 bags)	$ 6.00 (3 bags)
Order TOTAL --	$22.00	$41.00	$60.00

PRICE --	$72.00 (4 bags)	$90.00 (5 bags)	$108.00 (6 bags)
SHIPPING --	$ 7.00 (4 bags)	$ 7.50 (5 bags)	$ 8.00 (6 bags)
Order TOTAL --	$79.00	$97.50	$116.00

Mail completed form & check or money order made payable to: (Credit Cards Accepted)
Teresa Balkcum
10420 New Town Rd
Waxhaw, NC 28173