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To place an
order for RestRight Blocks, please fill out and print the following
form and mail with your payment to: |
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| Shipping Name: | |||
| Address: | |||
| Phone Number: | |||
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Purchase Code if Applicable: |
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| Check |
Credit Card |
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| Credit Card Number | |||
| Exp. Date | |||
| Signature | |||
| Quantity: | 2" RestRight Blocks King Size Beds $18.95 per set |
Amount: |
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| 2" RestRight Blocks King Size Beds $21.95 per set | Amount: | ||
| Amount: | |||
| . | . |
Total Dollar Amount: |
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| Tax: | 6.5% - Ohio only | Total Tax Amount: | |
| Shipping and Handling: |
U.S. Mail
$8.95 per
set |
Shipping Dollar Amount: | |
| Total Cost: $ | |||
