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___________________ COUNTRY____________________________POSTAL / ZIP CODE______________

All prices listed are in U.S. Funds.

	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 + $24.95 shipping
____	2 Grippers (list gripper strength)______________________________	$29.95 + $29.95 shipping
____	3 Grippers (list gripper strength)______________________________	$42.95 + $34.95 shipping
____	*Best Deal* All 6 Heavy Grips Hand Grippers (100, 150, 200, 250, 300, & 350)	$67 + $44.95 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