Beyond the Rainbow Order Form

Print Order Form and Mail, Email or Fax to
Beyond the Rainbow
PO Box 31672, St. Louis, MO 63131-0672 or
FAX 314-909-6617

ITEM#	ITEM DESCRIPTION	PRICE
__________	______________________________	__________
__________	______________________________	__________
__________	______________________________	__________
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	US Insured shipping and handling	$9.00
	Total	__________

In the continental United States, Insured shipping/handling is $9.00
All other Countries will be charged the Best Rate for Insured Air Mail.

  Print Name _________________________________________________________________________

  Mailing Address ______________________________________________________________________

  City, State, Zip Code ____________________    ___________________   ________

  Home & Cell Phone Number ___________________________    __________________________

  Work Phone _________________________________________   FAX ______________________

  Email Address ________________________________________________________________________

  Circle Payment Type      (MasterCard)     (Visa)     (Check)     (Money Order)

  Account Number __________________________________________________________________

  Credit Card Expiration Date __________________

  Name on card ______________________________________________________________________

  Please Sign & Date _________________________________  ____________________

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