Want to pay by Check? Just Print and Mail this Form!
Check Order Form
Send a Check or Money order To:
Aquarius Internet Inc.
Check Order Dept 14
11084 Blackhawk Blvd Davie, FL 33328
I would like to
Order:
1 Bottle Thermadrol at $33.97 Each Plus $5.99 Shipping Total $39.96
2 Bottles Thermadrol at $28.95 Each Plus
$5.99 Shipping Total $63.89
3 Bottles Thermadrol for $27.29 Each Plus $5.99 Shipping Total $87.86
Name______________________________________
Ship Address_____________________________________
Ship Address 2___________________________________
City__________________ State_________Zip_________
Phone______-________-________