ORDER FORM

Please print this page, fill it out and send it to the address below. FOR CREDIT CARDS ORDERS or PREFERRED CUSTOMER REGISTRATION SAVINGS-- CLICK ON HERE--->: Credit Card Orders

Please make check or money order payable to: Rigo Muniz. All payments outside the U.S. should be in U.S. funds. (No extra charge for outside U.S, except for the cost of shipping & handling.)

Name: __________________________________________

Company: _______________________________________

Street: __________________________________________

City: ____________________________________________

State/Province: __________________

ZIP: ___________________________

Country (if outside U.S.) _____________________________

KM 32 oz 1 bottle: $32

Shipping in USA: $6

Total: $38

How Many bottles?___________

Total Amount:________________

Mail orders to: