Please send me _____Spot  R&R Herbal Packs                                                     Number of packs ordered:

I prefer the color:__________                                                                                  Price: 

I prefer the following pattern scheme: masculine  feminine  (circle one)        Subtotal:    

  $6.00

  ______

Please send me _____Traditional  R&R Herbal Packs                                         Number of packs ordered:

I prefer the color:__________                                                                                  Price: 

I prefer the following pattern scheme: masculine  feminine  (circle one)        Subtotal:  

$11.00

_______

Please send me _____Mit-N-More  R&R Herbal Packs                                         Number of packs ordered:

I prefer the color:__________                                                                                   Price: 

I prefer the following pattern scheme: masculine  feminine  (circle one)         Subtotal:

$14.00

_______

Please send me _____Wrapper  R&R Herbal Packs                                               Number of packs ordered:

I prefer the color:__________                                                                                    Price: 

I prefer the following pattern scheme: masculine  feminine  (circle one)          Subtotal:  

______

$18.00

Please send me _____Maximum  R&R Herbal Packs                                              Number of packs ordered:

I prefer the color:__________                                                                                     Price: 

I prefer the following pattern scheme: masculine  feminine  (circle one)           Subtotal:  

$29.00  

________

Please send me _____Chilly Willy’s                                                             Number Chilly Willy’s  ordered:

I prefer the color:__________                                                                                      Price: 

I prefer the following pattern scheme: masculine  feminine  (circle one)            Subtotal:

_______

$5.00

_______

For “Chilly Willy’s”:

  Shipping: $1.00 each

  Colors: Red, blue, green, off white, black

Patterns: Bandana, Denim, Solid, Stars, Am. Flag, Etc.

Herbal Freight:

  $7.50 minimum or 15% of order

  *Sales Tax*

*Indiana and Wisconsin

Residents please add appropriate sales tax.

Order Subtotal:

Sales Tax*:

Make Checks Payable to:

      Champagne on Ice

Freight:

TOTAL:

________