www.NauseaReliefWristband.com

PSI BANDS - ORDER FORM
  Authorized Reseller:
(One Package Contains a Set of 2)
Fits wrists 5 1/4 inches to 8 1/4 inches in diameter
Quantity of Packages Price / Pkg. Total
Color Play OUT OF STOCK 15.00 OUT OF STOCK
Cherry Blossom OUT OF STOCK 15.00 OUT OF STOCK
Daisy Chain OUT OF STOCK 15.00 OUT OF STOCK
  Racer Black OUT OF STOCK 15.00 OUT OF STOCK
Block Party OUT OF STOCK 15.00 OUT OF STOCK
  Shipping (1st Pkg.) 3.50
(Add $ 1.00 for each additional pkg.) Additional Pkgs. 1.00
  ENCLOSED TOTAL OUT OF STOCK

Ship to:  Name ____________________________________________________________________

US Postal Service Address:  __________________________________________________________

City ________________________________________________  State _____   Zip _____________

Optional: Email address for order confirmation: ___________________________________________

May we have your phone number in case we have a question about your order? We do not sell/share this information with any third party.

Telephone:  ( ________ ) _________ - _______________

Please Make Your Check Payable to: Tribute Marketing and mail it with this form to:

Tribute Marketing, Attn: Cote, Box 802, Attleboro, MA 02703

Tel. 508-455-4646         email: info@nauseareliefwristband.com or info@tributemarketing.com