Child Alert Foundation Omezone TM Insect Repellent Skin Patch Special

Name:      ______________________________
Address: ______________________________
                 ______________________________
City:         ______________________________
State:      ___________    Zip:______________
Phone:    ______________________________
Email:     ______________________________

QTY

Unit Cost
$3.95  ea.

TOTAL
  Omezone TM Insect Repellent Patch Special   $1.25 Shipping & Handling Per Order

$_______
$1.25 S/H
$_______
Credit Card No: _________________________
Expiration: ____________ 		Name on Card: __________________________
3-4 digit code: _____
Payment:   Visa___    MC___   Amex___    Discover ___  Certified Check ___  Money Order ___


Mail Order to :
Child Alert Foundation
Box 357
Dushore, PA 18614