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Dr. Olson and Uneet Co. Inc. Order Form
(Please type all information and then print this form)

Name

Address

City State Zip Code

Telephone number Country

(Please include your telephone number so that we can discreetly call you if there are questions regarding your order)

Email address   Yes, send me future updates

Items

QUANTITY

COST EACH

TOTAL

Beaches 9 MONTH SUPPLY   $ 90.00  
Beaches 3 MONTH SUPPLY   $ 39.95  
HI-OCTANE +2   $ 24.95  
INCENSE STICKS   $ 14.95  
SUB TOTAL      
NEW JERSEY RESIDENTS ADD 6% SALES TAX      
SHIPPING AND HANDLING CONTINENTAL USA Only*   $ 4.05  
*SHIPPING AND HANDLING OUTSIDE CONTINENTAL UNITED STATES   $ 7.05  
TOTAL      

$15 RETURNED CHECK CHARGE.

Please make Checks and Money Orders payable to Uneet Co. in U.S. dollars drawn on a US bank only. Please allow 4 to 5 weeks for delivery when payment is made by check and 3 to 4 weeks for delivery when payment is made with a credit card, certified check or money order. Every effort will be made to expedite and deliver orders as quickly as possible.

Credit Card Orders (Master card, Visa, American Express, Discover):
Note: The card billing address must be the same as the shipping address for verification purposes. Transactions will be recorded as Uneet Co. Inc.

Card holder name  Card number  Expiration date   Customer signature _______________________

Please forward your order to:
Uneet Co.
275 Rte 10 East, Suite 220-188
Succasunna, NJ 07876

(Orders may also be faxed to 1-973-347-9220)                                               Dr. Olson