Man Slide - Mail Order Form

Man Slide - Mail Order Form

Please print this form, enter the required information and mail to:

Austin Research Institute
Dept. # MSL
P.O. Box 922
Hampstead, MD 21074
U.S.A.

PAYMENT OPTIONS

The following are pricing options for Man Slide (please circle one):

Only $ 19.99 for 4 oz. supply
Only $ 34.99 for 8 oz. supply
Only $ 47.99 for 12 oz. supply
Only $ 59.99 for 16 oz. supply
Only $ 72.50 for 20 oz. supply

Notes: Shipping is FREE. Maryland residents please add 6.0% sales tax. All prices are in U.S. Dollars.

We accept the following forms of payment (U.S. funds only):

cash

money orders

cashier's checks

  Note: We do not accept personal checks or COD's.

  Please make your payment payable to: Austin Research Institute

CUSTOMER INFORMATION

  FULL NAME: ____________________________________________________

  STREET ADDRESS: _______________________________________________

  CITY, STATE, ZIP: _______________________________________________

  COUNTRY/PROVINCE: ___________________________________________

  TELEPHONE NUMBER: ___________________________________________

  EMAIL ADDRESS: _______________________________________________

  Note: Your email address is needed in the event that we must contact you regarding your order.
  All of your information will remain completely confidential and will not be sold or given to anyone.

Your order will be shipped within 48 hours of receipt of payment. Thank you.