Special Features:  (Please print clearly) ________________________________________________________

$$Add On's ______________________________________________________

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Special Instructions: _______________________________________________

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CUSTOMER INFORMATION: (Please print clearly) (FAX to: 530-823-3288)

 Name: __________________________   Email:  _______________________

Shipping Address:______________________________________

City/State___________________  Zip _________________

Phone No. (_____) _______________________

Visa or MasterCard #: April will call you for your credit card information and to confirm your order within 24-hours.

 Security Code (last 3 numbers on back  _______

SKITO PAD: ____________________________________________________________

Other Tack: ___________________________________________________________

Easy Care Product Request
After visiting Easy Care and deciding what products you would like to buy, please write a description of what you would like to order below:
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Dynamite Nutritional Product Request
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