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Merchandise Order Form

Name
Address

City
State / Province
ZIP / Postal Code
Country
Phone
Email
Item #1		$
Item #2		$
Item #3		$
	subtotal
shipping	1-3 items	$ 4.00
Item #4		$
Item #5		$
	subtotal	$
add'l shipping	4+ items	$ 2.00
	total	$
	Mail printed form and payment to Woman Within International, Ltd. 10051 E Highland Rd, Suite 29-280 Howell, MI, 48843-6317