| Ship to: |
| Name:_________________________________________________________________ |
| Address :_______________________________________________________________ |
| City:____________________________________ST________ ZIP_________________ |
| E-Mail Address__________________________________________________________ |
| Phone#(_______)________________________________________________________ |
| VISA/MASTERCARD #___________________________________________________ |
| Exp _____-_____ CVV # ________ |
| Signature______________________________________________________ |
Address:___________________________________________________ City:___________________________ ST __________ ZIP______________ |
| Item Description | Qty |
Price |
Total |
| Planetary Earth Change Essence Master Blend (all 4 blends in one bottle - Earth Shift, Tremor Relief, Vibrational Balance and Moving up to 5th) | |||
| Master Blend - Dosage 1 fl. oz. | ____ | $15.95 | $_____________ |
| Master Blend -Stock Concentrate 1/2 fl. oz. | ____ | $19.95 | $_____________ |
| Planetary Earth Change Essence 4 separate blends | |||
| Earth Shift - Dosage 1 fl. oz. | ____ | $12.95 | $_____________ |
| Earth Shift - Stock Concentrate 1/2 fl. oz. | ____ | $16.95 | $_____________ |
| Tremor Relief - Dosage 1 fl. oz. | ____ | $12.95 | $_____________ |
| Tremor Relief - Stock Concentrate 1/2 fl. oz. | ____ | $16.95 | $_____________ |
| Vibrational Balance - Dosage 1 fl. oz. | ____ | $12.95 | $_____________ |
| Vibrational Balance -Stock Concentrate 1/2 fl. oz. | ____ | $16.95 | $_____________ |
| Moving up to 5th - Dosage 1 fl. oz. | ____ | $12.95 | $_____________ |
| Moving up to 5th - Stock Concentrate 1/2 fl. oz. | ____ | $16.95 | $_____________ |
Subtotal |
$_____________ | ||
| Shipping & Handling
(See Chart ) |
$_____________ | ||
Washington State Tax
8.9% (Orders shipped within Wash St. Only) |
$_____________ | ||
Order TOTAL |
$_____________ |
Shipping & Handling (continental US only) Order Amount S & H |
||||
1 Bottle $4.00 |
||||
2 Bottles $5.00 |
||||
| 3 to 6 Bottles $7.00
|
DaKara Kies Company is committed to the preservation of the Earth and makes a concerted effort to
use and reuse recyclable materials. You may receive you order in an unusual package or with a
combination of packing materials. We urge you to reuse whatever you can of the packing materials.
Thank you for your order!
Please email/mail or fax this completed form to the address above or call
with your Visa/Mastercard number.
Email to: Dakara@Dakara.com
Mail to: Dakara Kies Co
P.O. Box 1354
Marysville, WA 98270
(Orders mailed to the PO Box may incur a delay of shipping
of an additional week)
FAX: 425-953-4304
Return
to Dakara Kies Homepage
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