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A LITTLE HELP Model
THE ALTERNATE Model
PLUS SIZE Model
ATTACHABLE NIPPLES
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Home > alittlehelp-mailorderform
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PRINT FORM, WRITE IN INFORMATION, AND MAIL WITH PAYMENT TO ADDRESS BELOW
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Name:
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Address:
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City, State, Zip:
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Province, Country:
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Phone and Fax:
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Email:
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This is an Order for - A LITTLE HELP - Fits the Right Side OR the Left Side
FULL WEIGHT - $ 75 each LIGHT WEIGHT - $ 95 each
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CORRESPONDING BRA SIZES
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QUANTITY
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1
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32AA
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2
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32A 34AA
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3
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32B 34A 34B 36AA
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4
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32C 34B 36A 38AA
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5
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32D 34C 36B 38A 40AA
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6
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34D 36C 38B 40A 42AA
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7
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34DD 36D 38C 40B 42A
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8
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36DD 38D 40C 42B 44A
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9
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38DD 40D 42C 44B 44A
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10
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40DD 42D 44C 46B 44A
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A Tone
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B Tone
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C Tone
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D Tone
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Item Total
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Domestic Shipping ... $15
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Overseas Shipping ... $30
Available via Federal Express Air (Fed Ex Air) Only
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CA Residents add 7.75% Tax
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Grand Total
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Method of Payment:
DO NOT SEND CASH
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Check____ Cashier's Check____ M.O.____ Credit Card____
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Make Check or Money Order
Payable To:
John R. Schweitzer
Allow 10 days for delivery
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MAIL TO: John R. Schweitzer
1105 North Main Street
Jackson CA 95642
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PLEASE COMPLETE BELOW IF PAYING BY CREDIT CARD
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Name on Card:
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Card Number:
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Expiration Date:
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Please use your Internet Browser: FILE > PRINT to print out a copy of this document for mailing.
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