“CIRCULATOR” FOOT MASSAGE MAT

ORDER FORM

for orders from Ontario, Canada

Please note: If you are a wholesale customer, please contact us for wholesale pricing and opportunities.

Prices are in Canadian dollars

Please send me _______Circulator^® foot massage mat(s) at $39.95 each

Shipping & Handling: first mat $6.95

+ $1.95 each additional

Subtotal

Ontario residents add 13% HST

Total

I enclose full payment in the form of  bank draught  money order

Please make cheques and money orders payable to K. Baggio.

Name ___________________________________________

Address _________________________________________

_______________________________________________

City _____________________________________________

Province _________________ Postal Code _____________

Telephone ( )_____-________ Fax ( )_____-________

Signature ________________________________________________

Mailing address: The Circulator

c/o Baggio

6078 Old Church Rd.

Caledon East, ON

L7C 1G6