Order Tri-Way Promotions Products

Pay by Check SECURELY On-Line
ichecklogo2.gif (2474 bytes)

Item	Qty	Price	Shipping	Total
Hydrosport		$14.95	$4.95 each
Hydrator		$19.95	$4.95 each
Earth Powders Blush		$29.95	$5.95 each
Earth Powders Blush	Color: Peach Rose
Earth Powders Foundation		$29.95	$5.95 each
Earth Powders Foundation	Color: Light Medium Dark Deep
Earth Powders Bronzer		$29.95	$5.95 each
Earth Powders Bronzer	Color: Light Medium Dark Deep
Lasting Kiss		$19.95	$5.95 each
Lasting Kiss	Color: Brunette Blonde Redhead
DietCoach		$39.95	$6.95 each
OTHER
			Order Total
California Residents add 8.5% Sales Tax
Grand Total

Ordered By:
Name:
Address:
City:
State:
Zip Code:
Daytime Phone Number:
Evening Phone Number:
Fax Number:
E-Mail:

Ship To: (leave blank if same as above)
First Name:
Address:
City:
State:
Zip Code:

Payment Information:
*i-check payment*
Please enter any special instructions: