| 5-minute kids™ order form | ||||||
| Shipping: | Name | |||||
| Address | ||||||
| City | ||||||
| Phone | ||||||
| 5-Minute Kids Program | ||||||
| Item | Price | Quantity | Total Price | |||
| 5-Minute Kids Manual | $30.00 | |||||
| 50 Goal/50 Homework stickers | $5.00 | |||||
| 100 Goal stickers | $5.00 | |||||
| 100 Homework stickers | $5.00 | |||||
| 100 Goal/100 Homework stickers | $8.00 | |||||
| 48 Medicaid stickers | $3.00 | |||||
| 5-Minute Therapy Series | ||||||
| Item | Price | Quantity | Total Price | |||
| Volume 1 R | $18.00 | |||||
| Volume 2 S/Z | $18.00 | |||||
| Volume 3 L | $18.00 | |||||
| Volume 4 SH/CH | $18.00 | |||||
| Volume 5 K/G | $18.00 | |||||
| Volume 6 F/V/TH | $18.00 | |||||
| Complete Set of Six--save $9 | $99.00 | |||||
| Total order | ||||||
| FREE SHIPPING ON ALL ORDERS | ||||||
| Send payment to: | 5-Minute Kids | |||||
| 3580 Crestwood Drive | ||||||
| Lapeer MI 48446 | ||||||
| 810-664-5388 | ||||||
| FAX 810-356-5445 | ||||||
| Payment options: Checks (payable to 5-Minute Kids) Visa, Master Card, Purchase Orders, Paypal | ||||||
| Visit us at: www.5minutekids.com | ||||||