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

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Item #	Item Name	Price Each	Qty	Extended Cost	S & H
Total Cost
Total S & H
(Utah residents add 6.5% sales tax)
GRAND TOTAL

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