Color________________ Quantity________ Price Per Packet $1.50 X ______ = ____________

Color________________ Quantity________ Price Per Packet $1.50 X ______ = ____________

Color________________ Quantity________ Price Per Packet $1.50 X ______ = ____________

Color________________ Quantity________ Price Per Packet $1.50 X ______ = ____________

Color________________ Quantity________ Price Per Packet $1.50 X ______ = ____________

Color________________ Quantity________ Price Per Packet $1.50 X ______ = ____________

Please Enclose A Check Payable to Jeanne Calvin. . .Making a note at the Bottom "Water Beads"
     and Mail to:   28268 Palm Villa Drive,  Menifee,  Ca.  92584    951-723-4141
     To Print out This Form:  Right click your mouse and select PRINT

Name____________________________________________+ Date________________________

Address_______________________________________________________________________

Phone ______________________________Check #______________Amount________________

email address___________________________________________________________________

Signature_____________________________________________Water Beads are Non-Refundable