Print this form, then fill in the requested information and fax to: 435-635-9005 or mail it with payment to:
Life Studies, LLC 490 S. 400 W. Hurricane, UT 84737

Name:		Phone:
Address:
City:	State:	Zip:

Item #	Item Name	Price Each	Qty	Extended Cost	S & H
Total Cost
Total S & H (Maximum $8.00)*
(Utah residents add 6.25% sales tax. In Canada add 30% for extra shipping cost. If paying in Canadian funds with a check add an additional 30% to cover the exchange rate.)
GRAND TOTAL

To order with your Visa or Mastercard, please fill in the following information:
Card Holder's Full Name:
16 digit Card Number:
Expiration date:

Note: we do not accept American Express, Discover, or other cards. Visa and Mastercard only.

* Shipping charges are added for each item until total shipping cost reaches $8.00. You will not be charged more than $8.00 for shipping cost even if the order form shows a higher total. Exceptions are FEDEX shipments and bulk orders (10 items or more). For shipping rates on Fedex, UPS, or bulk shipments please call toll free: 1-877-864-2207 or 1-435-635-3244 if calling from outside the USA.