“CIRCULATOR” FOOT MASSAGE MAT

ORDER FORM

for orders from the U.S.A.

Please note: If you are a wholesale customer, please contact us for wholesale pricing and opportunities.

Price is in U.S. dollars.

Please send me _______F.M. Circulator^® foot massage mat(s) at $39.95 each	$
Shipping & Handling: $9.95 one mat + $2.95 each additional
Total	$

I enclose full payment in the form of  cheque  money order

Please make cheques and money orders payable to K. Baggio.

Name ___________________________________________

Address _________________________________________

____________________________________________

City ____________________________________________

State ___________________ Zip Code _______________

Telephone ( )_____-________ Fax ( )_____-________

Signature ________________________________________________

Mailing address: The Circulator

c/o Baggio

6078 Old Church Rd.

Caledon East, ON

Canada L7C 1G6