| Sold to: ________________________ |
Ship to (if different): ________________________ |
| Name ________________________ |
Name ________________________ |
| Address ________________________ |
Address ________________________ |
| City, State, Zip ________________________ |
City, State, Zip ________________________ |
| Daytime phone ________________________ |
Daytime phone ________________________ |
| Quantity |
Description |
Unit Price |
Total |
| ____________ |
Aqua Tunes w/Deluxe speakers |
$44.99 |
$ |
| ____________ |
Aqua Tunes 2 for MP3 Players |
$44.99 |
$ |
| ____________ |
Deluxe Earplug Speakers |
$19.99 |
$ |
| ____________ |
Aqua Tunes Universal Pouch |
$15.00 |
$ |
| ____________ |
Aqua Tunes 2 For MP3 Pouch |
$15.00 |
$ |
| ____________ |
Aqua Tunes Clamp |
$10.00 |
$ |
| ____________ |
Belt Extension |
$1.00 |
$ |
| ____________ |
Headband Medium or Large (circle choice) |
$3.49 |
$ |
| ____________ |
Bioceramic Swim Cap - White, Black, Red or Blue (circle choice) |
$9.99 |
$ |
| ____________ |
Seal Swim Mask - Clear |
$24.99 |
$ |
| ____________ |
Malibu 2000 Swimmers' Shampoo |
$7.99 |
$ |
| ____________ |
Malibu 2000 Swimmers' Conditioner |
$7.99 |
$ |
| ____________ |
Malibu C-Crystal Swimwear Rinse |
$7.99 |
$ |
|
Shipping and Handling:
(Continental USA only - 48 Contiguous states. Email or call for rates for all
other orders)
Orders $10 and less: $4.00 $________________
Orders over $10: $8.00 $________________
Tax:
(Colorado residents must add 3% State sales tax plus all applicable local taxes) $______________
TOTAL: $_____________________
Method of payment: (sorry no COD's): VISA or Mastercard
Account # ________________________ Expiry Date:__________________
Cardholder Name: __________________________ Signature:___________________________
|