GLOVES IN A BOTTLE ORDER FORM
For USA & Canada Residents Only

	We are so certain that you will love Gloves In A Bottle that we unconditionally guarantee it. If for any reason you are not completely satisfied, simply return the unused portion along with the original receipt and we will promptly refund your entire purchase price with no questions asked. Our goal is that you receive more than what you expected.
To order a product, select the quantity you want and click on the "Add to Order" button. It will take you to our secure online shopping cart.
Note: California residents will have 9.75% sales tax added to their orders.
PRODUCT DESCRIPTION	COST	QUANTITY
8 oz. bottle of Gloves In A Bottle. Shipping for up to 3 bottles will be $7.95.Order 4 or more bottles and get free shipping within USA	$14.95 each	Bottles:
Case (12) 8 oz. bottles of Gloves In A Bottle. Free Shipping within USA!	$158.00 ($13.17 per bottle)	Cases:
1 Gallon bottle of Gloves In A Bottle. Free Shipping within USA!	$159.00	Gallons:
Case of 4 Gallons of Gloves In A Bottle. Free Shipping within USA!	$448.00	Cases of 4 Gallons:
3 Sample Packets of Gloves In A Bottle. Free - only a postage & handling charge!	$2.00 1 order = 3 packets	3 packets of Samples:
Note: You will be asked for your credit card information by our secure shopping cart (Dansie Cart). Your privacy will be respected and your information used only to process this order. Also note allow 7 business days for delivery.
HOW DID YOU FIND OUT ABOUT GLOVES IN A BOTTLE? We will send you FREE SAMPLES with your order for doing this 10 second survey Doctor? Name of the Doctor:* Store? Store Name:* Friend? Magazine article? Name of Magazine:* Newspaper Article? Name of Newspaper:* Internet Article? Name of Internet Article:* Search Engine key word search? What was the key word(s) phrase you searched for?* Which Search Engine did you use?* Other Please, indicate the source*: First Name, Last Name* (only so we know to include free samples with your order)

* Gloves In A Bottle, Inc. makes no claims that its product could be used in the diagnosis, cure, mitigation, treatment, or prevention of eczema, psoriasis, skin allergies, dermatitis, or any other disease; or is intended to affect the structure or any function of the body.

Gloves In A Bottle is not intended to protect against any chemicals or irritants other than dirt and grime. Always follow manufacturer's safety directions when handling any harmful substance. Gloves In A Bottle is not a substitute for required safety protection, including gloves.