Alternative Payment Methods: Cheque, Postal order, Travellers cheque, made payable to:

RT & Associates (Diet Water Stick)
Postal Address: PO Box 731,  Crawley, Sussex, RH11 7WJ  (United Kingdom)

PRINT THIS PAGE, COMPLETE THE ORDER FORM, AND SEND TOGETHER WITH PAYMENT

Name:            _____________________________________________

Address:         _____________________________________________

                 _____________________________________________Post Code:___________

Telephone No:    _____________________________________________

E-Mail address:  _____________________________________________

I wish to purchase:

Signed:  ________________________________________________
 
Payment for total amount to be made payable to RT & Associates. 
Conditions of sale: Once cheque is cleared the order will be sent.

** To help us be more efficient please include your e-mail address **
- PLEASE PRINT THIS PAGE AND SEND WITH PAYMENT -

Prices are subject to change: Prices current as of Jan 1st 2009