Order Form

Get YourDOUBLE STRENGTH
 Miracle Relief FormulaŽ At The 
Special Low Price Of Only $29.95 A Jar!

   YES!  Rush me one 4 oz. Jar of Miracle Relief FormulaŽ @ $29.95 plus $4.00 shipping & handling.                  

 YES!  I am Ordering 3 Jars of Miracle Relief FormulaŽ for a total of  $99.85. ($89.95 plus $10.00 shipping),   AND I GET A 4th JAR FREE!  A savings of $29.95.                                                                                               

Mail Orders to:
Rickey Tiller
300 S.E. M.L.K. Jr. Blvd.
Stuart, FL 34994
E-Mail: rickeytiller44@yahoo.com 

  Enclosed is: ($ Total).  I am paying by:  
[]Check  [] Money-Order  

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