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Name: SPECIAL "PRE-RETAIL" PROMOTIONAL PRICE:
Address: $14.99 per bottle + $4.95 per bottle (S&H)
City - State - Zip: TOTAL COST = $19.94 per bottle (INCLUDING S&H)
Phone Number: Number of Bottles Ordered: _________
Email Address: TOTAL AMOUNT (Enclosed): _________
MAIL PAYMENT TO: Y3Kusa - 2390 Crenshaw Blvd., Ste 360, Torrance, CA 90501 USA
* Don't forget to include your contact information and mailing address with your payment.
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