Order Form

Gods Remedy Print Order Form

Print - Then mail this order form To:

Gods Remedy
PO Box 310 Safety Harbor, Fl 34695-0310
Or Fax To (727) 726-5301

Ship To:

Name:__________________________________

Address:_________________________________

City:____________________________________

State:_____________ Zip:____________________

Phone:___________________________________

Quantity	Description and Size	Price Each	Total Price







	Domestic Orders over $200 free	Subtotal
	Shipping &	handling	$8.00
	email info@godsremedy.com for international orders	Total

METHOD OF PAYMENT

Place an X on Payment Choice line

____ VISA

____ MASTER CARD

_____ DISCOVER

_____ MONEY ORDER

_____ CHECK : made out to Gods Remedy (US$)

CARD #______________________________

EXP DATE _____________/____________

Billing address: If you are using a credit card, make sure the address above is where you receive your credit card statement. If not, print billing address below:
NAME ___________________________________

ADDRESS_________________________________

CITY_________________________ STATE______

ZIP CODE________________COUNTRY_________

If you are not fully satisfied, just return the unused products and God's Remedy will supply a full money back guarantee within 30 days of receipt.