Print this form, then fill in the requested information and fax to: 435-635-9005 or mail it with payment to:
Life Studies, LLC 490 S. 400 W. Hurricane, UT 84737

Name:		Phone:
Address:
City:	State:	Zip:

Item #	Item Name	Price Each	Qty	Extended Cost	S & H
Total Cost
Total S & H (Maximum $16.17)*
(Utah residents add 6.35% sales tax.)
GRAND TOTAL

To order with your Visa or Mastercard or AMEX, please fill in the following information:
Card Holder's Full Name:
16 digit Card Number:
Expiration date:

Note: we do not currently accept  Discover cards.

* Shipping charges are added for each item until total shipping cost reaches $16.17. You will not be charged more than $16.17 for shipping cost even if the order form shows a higher total. Exceptions are FEDEX shipments and bulk orders (10 items or more). For shipping rates on Fedex, UPS, or bulk shipments please call toll free: 1-877-864-2207 or 1-435-986-8400 if calling from outside the USA.