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| *Make checks payable to: L. Nguyen | |
| Shipping Address: | |
| Name: | _________________________________________________________________________ |
| Address: | _________________________________________________________________________ |
| City: | _________________________________________________________________________ |
| State, zip: | ___________ __________ |
| Email: | _________________________________________________________________________ |
| Phone: | (_____) _____ - ________ |
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| QTY | Full Name |
Price Each |
Total | |
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Magnetized Water - Magnetic Cup Holder Disc |
$14.95 | |||
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1 to 3 Disc =
$2.00 Each additional disc add $1.00 |
Shipping & Handling: | |||
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Order Total: |
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| Note: **Your order will be shipped in 5 - 10 business days | ||||
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