Alternative Payment Methods: Cheque, Postal order, Travellers cheque, Cash (use recorded courier) 
made payable to:

RT & Associates (Diet Water Stick)
Postal Address: PO Box 731,  Crawley, Sussex, RH11 7WJ  (United Kingdom)
PRINT THIS PAGE, COMPLETE THE ORDER FORM, AND SEND TOGETHER WITH PAYMENT
Name:            _____________________________________________
Address:         _____________________________________________
                 _____________________________________________Post Code:___________
Telephone No:    _____________________________________________
E-Mail address:  _____________________________________________
I wish to purchase:
PRODUCT NAME

CODE

PRICE

QTY

SUB TOTAL

Diet Water Stick®   x 1 DWS  001 £12.50 ea £

FREE...Sport Bottle with purchase

1 (free)

Post and packing...FREE, UK Mainland
International: EMAIL for postage cost


£


Total

£
Signed:  ________________________________________________
 
Payment for total amount to be made payable to RT & Associates. 
Conditions of sale: Once cheque is cleared the order will be sent.

** To help us be more efficient please include your e-mail address **
- PLEASE PRINT THIS PAGE AND SEND WITH PAYMENT -
Prices are subject to change: Prices current as of Jan 1st 2009