Please fill out this form completely and enclose your money order or cashiers check.
Name: ___________________________________
Address: _________________________________
_________________________________________
E-mail: ___________________________________
Product: circle one LARGE MEDIUM
quantity # ___ # ___
Total for products: $24.99 X ___ = _______
Add: Priority Shipping $7.99 X 1 = _______
each additional $4.99 X ___ = _______
or
Add: Parcel Post Ship $6.99 X 1 = _______
each additional $4.99 X ___ = _______
Total Amount: _________
Send Cashiers check or Money Order payable to:
(Sorry, No Personal Checks)
Your Breast Friends
3509 Baker Road
Suite 403-165
Acworth, GA 30101
Please allow up to 2-3 weeks for delivery
(Products will be shipped within 3 business days of receipt of order)
