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Kombucha Products Order Form
Please print page, fill in form, and mail with check or
money order
(payable to H.D. Brown) to:
H.D. Brown/kombucha
68 E. Orvis St., # F
Massena, NY 13662
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Name: ______________________________________________
Address:____________________________________________
City:_________________________ State/Country:___________
Zip/Country code:__________
Quantity: -------------------- Item: -------------------------- price
------------- Total(s)
______ 2 Kombucha Cultures & Instructions ------- $25.00
---------- ________
______ 2 K Cultures, instructions + 1 qt. K Tea ------$50.00
---------- ________
______ 1/2 gallon ready-made K-Tea ----------- $50.00 ----------
________
Above prices include shipping and handling within continental U.S. via
U.S. Postal Priority Mail.
Additional Shipping for orders outside continental U.S. -----------
$15.00 - ________
----------------------------------------------------------------------------Total
_________
Orders will be shipped U.S. Postal Priority Mail (other if checked,
with payment enclosed)
email; websites@osplanet.org for kombucha/order inquiries.
E-mail: ________________
Phone #: _______________
Additional instructions/comments: