LEIS OF HAWAII

POLYNESIAN BROWN TANNING OIL

Date Ordered: Date of Delivery:

PLEASE CHECK ONE - SHIPPING TO BUSINESS - SHIPPING TO RESIDENCE

                                                                

Company Ship To:

c/o Name:

Address:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

Contact Name:

How did you hear of our company?


Per 8 oz. Bottles

*POLYNESIAN BROWN OIL*

Individual

- - - - - - - - - - - - - - - Type Of Item - - - - - - - - Bottle Count & Price - - - - - - - - - - - - - - - - Total

*Individual - 8 oz. Bottle - Natural*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 8 oz. Bottle - w/SPF 4*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 8 oz. Bottle - w/SPF 15*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 8 oz. Bottle - w/SPF 30*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $


Per 16, 4, 2, 1 oz. Bottles

*Bottles listed below are special orders only.*

- - - - - - - - - - - - - - - Type Of Item - - - - - - - - Bottle Count & Price - - - - - - - - - - - - - - - - Total

*Individual - 16 oz. Bottle - Natural*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 16 oz. Bottle - w/SPF 4*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 16 oz. Bottle - w/SPF 15*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 16 oz. Bottle - w/SPF 30*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $


*Individual - 4 oz. Bottle - Natural*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 4 oz. Bottle - w/SPF 4*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 4 oz. Bottle - w/SPF 15*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 4 oz. Bottle - w/SPF 30*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $


*Individual - 2 oz. Bottle - Natural*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 2 oz. Bottle - w/SPF 4*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 2 oz. Bottle - w/SPF 15*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 2 oz. Bottle - w/SPF 30*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $


*Individual - 1 oz. Bottle - Natural*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 1 oz. Bottle - w/SPF 4*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 1 oz. Bottle - w/SPF 15*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $

*Individual - 1 oz. Bottle - w/SPF 30*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                

Qty () X = $


Per 8 oz. Bottles

*POLYNESIAN BROWN OIL*

PLEASE CHECK ONE - Spray Top ---------- or ---------- Flip Top

                                                                 

Volume

- - - - - - - - - - - - - - - Type Of Item - - - - - - - - Bottle Count & Price - - - - - - - - - - - - - - - - Total

*Volume - 8 oz. Bottle - Natural*

Qty () X = $

*Volume - 8 oz. Bottle - w/SPF 4*

Qty () X = $

*Volume - 8 oz. Bottle - w/SPF 15*

Qty () X = $

*Volume - 8 oz. Bottle - w/SPF 30*

Qty () X = $


Per 16, 4, 2, 1 oz. Bottles

*Bottles listed below are special orders only.*

- - - - - - - - - - - - - - - Type Of Item - - - - - - - - Bottle Count & Price - - - - - - - - - - - - - - - - Total

*Volume - 16 oz. Bottle - Natural*

Qty () X = $

*Volume - 16 oz. Bottle - w/SPF 4*

Qty () X = $

*Volume - 16 oz. Bottle - w/SPF 15*

Qty () X = $

*Volume - 16 oz. Bottle - w/SPF 30*

Qty () X = $


*Volume - 4 oz. Bottle - Natural*

Qty () X = $

*Volume - 4 oz. Bottle - w/SPF 4*

Qty () X = $

*Volume - 4 oz. Bottle - w/SPF 15*

Qty () X = $

*Volume - 4 oz. Bottle - w/SPF 30*

Qty () X = $


*Volume - 2 oz. Bottle - Natural*

Qty (