Moonlight Mysteries: Mystical Gifts and Accessories

MOONLIGHT MYSTERIES
MYSTICAL GIFTS AND ACCESSORIES
http://www.moonlightmysteries.com

PO Box 486
Caledonia, MI 49316
USA
(616)891-2264
service@moonlightmysteries.com

STOCK #	DESCRIPTION OF ITEM	SIZ/CLR	QTY	UNIT PRICE	TOTAL
sa-111	Sample Item	black	2	$1.00	$2.00

Subtotal	________
Shipping and Handling	+ 5.95*
Grand Total	________

BILLING ADDRESS:
Name:
Street:
City:
State/Zip:
Day Phone: ( ) -
E-mail:

SHIP TO ADDRESS:
Name:
Street:
City:
State/Zip:
Day Phone: ( ) -
E-mail:

Make checks and money orders payable to:
Moonlight Mysteries

*United States rate only. Please call or email for rate outside US.

FOR PAYMENT BY CREDIT CARD

Credit card: [ ] Visa [ ] Mastercard [ ] Discover	Expiration Date : _ _ of _ _
Credit Card Number : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	Signature:

Billing address and cardholder information must match. We cannot process without a signature.

Thank you for your order!

Due to government regulations we cannot guarantee the effectiveness of a product for medical or occult purposes.
If you are suffering from a medical condition please consult a health care provider.