Heavy Grips Hand Gripper Order Form
Please note this order form is for USA and Canada orders only.
If you are ordering from outside the USA or Canada please visit
http://www.leehayward.com/heavygrips_int.htm

To order print a copy of this page, fill it out, and mail it to the address below.

(Please Print Clearly)

NAME_____________________________________________________________

E-MAIL ADDRESS___________________________________________________

ADDRESS__________________________________________________________

__________________________________________________________________

CITY___________________PROV / STATE______POSTAL / ZIP CODE_________


  PLEASE CHECK AND LIST THE GRIPPERS YOU WANT TO ORDER
(i.e. 100, 150, 200, 250, 300, or 350)		 AMOUNT
____ 1 Gripper (list gripper strength)_______________________________ $15.95 + $9.95 shipping
____ 2 Grippers (list gripper strength)______________________________ $29.95 + $10.95 shipping
____ 3 Grippers (list gripper strength)______________________________ $42.95 + $11.95 shipping
____ 4 Grippers (list gripper strength)______________________________ $54.95 + $12.95 shipping
____ 5 Heavy Grips Hand Grippers (100, 150, 200, 250, & 300) $59.95 + $13.95 shipping
____ *Best Deal* All 6 Heavy Grips Hand Grippers (100, 150, 200, 250, 300, & 350) $67 + $14.95 shipping
Check Payment Method:    Cash____    Check____     International Money Order____

We can only process "International Money Orders". Please DO NOT send regular money orders.
If buying a money order, make sure to ask the clerk for an "International Money Order".

Please make checks and money orders payable to "Lee Hayward".


MAIL TO:

Lee Hayward
P.O. Box 13175
Station Topsail
CBS, NL, A1W 2K1
Canada

As soon as your order is received
you will be contacted via e-mail.

www.LeeHayward.com