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Please provide the following contact information:

Name
Title
Organization
Name of Zingbat® Recipient
Street Address
Address
City
State
Zip Code
Work Phone
Home Phone
FAX
E-mail
Web Site

Please provide the following ordering information:

QTY	AGE	WEIGHT	PRICE	INTRODUCTORY PRICE
	5 - 7 years of age	30 - 50 pounds	$ 119.75	$ 99.75 ***
	8 - 10 years of age	50 - 80 pounds	$ 129.75	$109.75 ***
	11 - 14 years of age	80 - 110 pounds	$ 139.75	$119.75 ***

*** For a limited time only.  Above price does not include shipping and handling and sales tax where applicable.
     Training manual and instruction video are included.

	BILLING
Credit Card	VISA MasterCard American Express Diner's Club Discover
Cardholder Name
Card Number
Expiration Date

 

	SHIPPING
Billing Name
Street Address
Address
City
State/Province
Zip/Postal Code
Country

Please identify and describe Zingbat® recipient:

Age
Weight