MERCHANDISE ORDER FORM

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Ship to:                                                     
Address:                                                     
City, State, Zip Code:                                                     
Cash:          Check:          Visa:          M/C:     
Credit Card #:                                                     
Exp Date:      -      

Quantity
Size
Unit Price
Total
       
 
       
 
AVOID DELAYS - INCLUDE SHIPPING AND HANDLING  
 
Orders up to $20.00 ... $4.98
From 20.00-40.00 ........ $6.98
From 40.00-60.00 ........ $8.98
Orders over $60.00 .... $11.98
 California Residents
Add 7.5% Sales Tax		  
 
 
 

SORRY NO CODS -- SATISFACTION GUARANTEED OR MONEY BACK

Mail To:

Asepsis Technology
323 Willow Glen Court
Healdsburg, CA 95448

... or ORDER TOLL FREE
(800) 593-ASEP