$10.00 DISCOUNT
FOR MAIL IN ORDERS OF $100 OR MORE ONLY PAID BY CHECK OR MONEY ORDER
Nature's Rx - Mail in Order Form
2 Nature's Way, Paoli, OK, USA 73074
405-484-7302
E-Mail:   naturesrxx@hotmail.com
(Ref# N50007)

Product & Specials Reference List

Quantity Item Price
     
     
     
     
     
     

*Total  
Shipping   Click here for Rates  
* Your "Total" must be $100 or more to qualify    Deduct $10  
Total Amount Due  

Shipping Address   (Ref# N50007)
Name
Address:
City:
State                      Zip/Postal
Phone Number (optional)
Email Address (optional)
Method Of Payment     Check____Money Order____

Mail this completed form with your check or money order to:
Nature's Rx Inc., P.O. Box 445, Paoli, OK 73074

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