CoolBlueGel.com Mail Order Form
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525 E. 5th
St., Bloomsburg, PA 17815 USA
www.CoolBlueGel.com
Email: DNLLCUSA@aol.com
Customer
Assistance: 1-570-380-1320
YOUR INFORMATION:
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Name: |
Date: |
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Billing
Address: |
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Billing City, State, Zip: |
Email: |
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Phone: |
Fax: |
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Shipping Address: |
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Shipping City, State, Zip: |
**REQUIRED: |
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Method of Payment: ____VISA
_____Mastercard
_____AmExp _____Discover $$$ |
“V”# (back of card)________ |
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Credit Card No.:
Signature: |
Exp. Date: / |
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***Make Checks Payable to: Dromaius Novae’
LLC _____Check Enclosed*** |
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CODE |
PRODUCT |
PRICE EA. |
QTY. |
TOTAL |
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CGB4 – 1 |
4 oz. Cool Blue Gel – 1 Bottle |
$19.95 USD |
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$ |
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CBG4 – 2 |
4 oz. Cool Blue Gel – 2 Bottles – SAVE $15 |
$34.90 USD |
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$ |
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CBG4 – 3 |
4 oz. Cool Blue Gel – 3 Bottles – SAVE $30 |
$49.85 USD |
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$ |
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CBG4 – 4 |
4 oz. Cool Blue Gel – 4 Bottles – SAVE $45 |
$64.80 USD |
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$ |
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CGBMS |
4 oz. Cool Blue Gel – 1 Bottle – MONTHLY SHIPMENT CLUB –
Each month hereafter, you will only be charged $14.95 per 4 oz. Bottle. Can Cancel at any time. Must purchase
first bottle @ $19.95. |
$14.95 USD |
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$ |
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Sign to join |
Monthly Shipment Club:______________________ |
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QUESTIONS? Call 570-380-1320
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Order Total |
$ |
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Shipping/Handling = $6.95 (Canada $14.95) |
$ |
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PA Residents Sales Tax – None for Analgesics |
$ |
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$ |
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TOTAL PAYMENT ENCLOSED |
$ |
PRICES SUBJECT TO CHANGE WITHOUT NOTICE. All Prices in U.S. Dollars. Export Orders = Additional S/H Charges.
*We will notify you promptly if your item is backordered and
will ship as soon as available.
Thank you for your order!
We sincerely appreciate it.
Visit us on the internet at www.CoolBlueGel.com.
Email us at COOL
BLUE GEL
©2006 Dromaius Novae’, LLC.
All Rights Reserved 05/18/06