Mail to:

	Growth Plus of Canada,
	Box 129,
	Lone Butte, BC, Canada
	V0K 1X0


Name:      _____________________________________________________

Address:   _____________________________________________________

City:      _____________________________________________________

Country:   _____________________________________________________

Postal/ZIP:_____________________________________________________

eMail:     _____________________________________________________

Mastercard only(Canadian or US) or money order are accepted.
All prices are in USD (United States Dollars)

Card#________________________________ Expiry:____________

Growth Plus Shampoo and Conditioner    #ordered | total
  90 day supply @ $39.95                 ______ | _______
                    shipping (US)         $25.00| _______
                    shipping (Can)        $17.50| _______
                    shipping (BC)         $10.00| _______
                    shipping (other)     contact| _______
                    subtotal                    | _______
                    Canada only        GST    7%| _______
                    BC Residents       PST  7.5%| _______
------------------------------------------------|
                                       total    | _______