Antsalive Order Form
Print this form, then fill in the requested information and fax to: 435-635-9005 or email to: info@antsalive.com.
You can also mail this form 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 | |||||
| (Utah residents add 6.5% sales tax) | |||||
| GRAND TOTAL | |||||
| To order with your Visa or Mastercard, please fill in the following information: | |
| Card Holder's Full Name: | |
| 16 digit Card Number: | |
| Expiration date: | |
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