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ORDER FORM
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ENERGY CUBES
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| ENERGY Cubes (1" x 1" x 1")
Cost : $20. per pair in Birch. Shipping and Handling: $3./pair |
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Please Print, and Mail Order Form to:
Infinite Branches 515 W. Bethel Road Bethel, ME 04217 603-466-2265 info@infinitebranches.com |
| Name of Purchaser | |
| Name of Recipient | |
| Shipping to Recipient rather than Purchaser? ____Yes ___No | |
| Shipping Address | |
| Telephone # of Purchaser | |
| Email Address of Purchaser | |
| Specific Wellness Energy: | |
| or energy the recipient most needs at the time? ___Yes | |
| Check Amount Enclosed: | |
| Amount to charge to card: | |
| Visa____or Mastercard___ | |
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Card Number
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V Code
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| Signature of cardholder: | |
| Note: Maine residents must add 5% sales tax |