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EnergyPlates.com • 15508 W Bell Rd Ste 101-438 • Surprise,
Arizona 85374
• Phone: 1-877-877-0747 • Fax 1-623-321-9977 •
• E-Mail:
•
(Please Print)
See **Payment Method Below**
| Name (as it appears on the credit card) | ||
| Address Line 1 | ||
| Address Line 2 (optional) | ||
| City | State/Prov./Prefecture | Postal Code |
| Country (if not USA) | ||
| E-mail Address (needed for order confirmation) | Home
Phone ( ) |
Office
Phone ( ) |
| Credit Card Number with Security Code | Card (Visa, MC, Discover, Amex, Diners, Carte Blanche, JCB) | Expiration Date |
| Name of Recipient (if different, optional) | ||
| Shipping Address (if different, optional) | ||
| Shipping Address Line 2 (if different, optional) | ||
| City | State/Prov./Prefecture | Postal Code |
| Country (if not USA) | ||
Don't want to print out the large order form? For a compact, blank order form CLICK HERE!
§ This symbol denotes a special discounted item. No coupons or other offers are valid with discounted items.
| Item | Description | Quantity | Unit Price | Subtotal |
|
PEP5 |
Positive Energy Plate (2¾" x 4½") | $15.00 |
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PEP5X6 |
Positive Energy Plate (2¾" x 4½") 6-pack | § | $80.00 |
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PEP12 |
Positive Energy Plate (12" x 12") | $45.00 |
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PEP12X6 |
Positive Energy Plate (12" x 12") 6-pack | § | $240.00 |
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PEAS |
Positive Energy Purple Angel Small (1 3/8" x 1 3/8") | $10.00 |
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PEASX6 |
Positive Energy Purple Angels 6-pack Small | § | $54.00 |
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PEAL |
Positive Energy Purple Angel Large (2 1/8" x 2 1/8") | $12.00 |
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PEALX6 |
Positive Energy Purple Angels 6-pack Large | § | $65.00 |
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PEDS |
Positive Energy Purple Disk Small (1" x 1") | $7.50 |
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PEDSX6 |
Positive Energy Purple Disks Small (1" x 1") 6-pack | § | $36.00 |
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PEDL |
Positive Energy Purple Disk (1½" x 1½") | $7.50 |
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PEDLX6 |
Positive Energy Purple Disk (1½" x 1½") 6-pack | § | $36.00 |
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PEFF |
Positive Energy Fridge Freshener | $30.00 |
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PETB |
Green Thumb Positive Energy Tube | $25.00 |
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PEFIS |
Positive Energy Fuel Ionizer (Small) | $40.00 |
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PEFIL |
Positive Energy Fuel Ionizer (Large) | $85.00 |
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PEPI |
Positive Energy Pool Ionizer | $300.00 |
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PEHC |
Hunza Water Conditioner | $200.00 |
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Coupon #: _____________________ |
-$ |
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Comments:
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TOTAL: |
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Shipping and Handling |
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USA |
International Shipping will be determined by Weight and Country at time of shipment. Please e-mail for final shipping charges. |
Thank you
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**PAYMENT METHOD**
Payment will only be accepted made
out to Scot Brown.
Please pay amount due in cash, check, or money order.
International orders payable in US Funds preferred
as a Money Order from your Post Office.
International Money Order also accepted. Please follow above note.