Order Form:   Print this order form. To order from your own Colesce Independent Consultant,
Change the above name and address to that of your own Colesce Independent Consultant.
Send by Snail Mail or Fax/ or Copy to an E-Mail message    to Mabel or your own Colesce Independent Consultant.
Make Check or Money Order Payable to: MABEL E. KOPP or the name of your own Colesce Consultant.

Special Instructions:___________________________________________________________________________

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BILLING/SHIPPING ORDERING INFORMATION:   * Note:    I respect The Privacy of all My Customers, their names, address and phone numbers, whether Published or Non Published.    I do not distribute in any way, Names, E-Mail, phone numbers, addresses, or mailing addresses. The Number of Items being shipped to THIS Address_______ "MAIN"
Bill to Name:________________________________________  Street Address:______________________________________  Address:___________________________________________  City:___________________________ State: ____ Zip: _______	Date:______________________   Apt#______________________   *Phone (Day): _________________ *Unlisted? ____   *Phone (Evening): ______________ *Unlisted? ____

Payment Information:    Check ___  Money Order ___    Check/Money Order #_______________________  Charge_____   Orders $35.00 or more       Credit Card Information    Circle One:     VISA,   MasterCard,   Discover  Card Number:_______________________________________   Expiration Date:____________ Name of Authorized Card Holder:_________________________________  Address:___________________________________      *Phone (Day):________________ *Unlisted?____ Address:___________________________________      *Phone (Eve):________________ *Unlisted?____ Signature of Authorized Card Holder:_______________________________________________

GIFT / Recipient SHIP to (if different from above) Number of Items send to this address _____  IS THIS A GIFT?   Yes  No  GIFT / Recipient ID   "A"  GIFT Wrap _______ GIFT Bag _______ Name:____________________________________________  Address:__________________________________________  Address:__________________________________________  City:_________________________ State: ___ Zip: _______

FOR GIFT   Supply Gift Card Information. Use seperate sheet for each additional recipient. Distinguish each recipient by a unique "GIFT / Recipient ID" and indicate "Gift Wrap" $5.00 each or "Gift Bag" Free Message:____________________________________________              ____________________________________________      Apt#______________________   *Phone (Day): _________________ *Unlisted? ____   *Phone (Evening): ______________ *Unlisted? ____

GIFT / Recipient SHIP to (if different from above) Number of Items To send to this address _____  IS THIS A GIFT?   Yes  No  GIFT / Recipient ID   "B"  GIFT Wrap _______ GIFT Bag _______ Name:____________________________________________  Address:__________________________________________  Address:__________________________________________  City:_________________________ State: ___ Zip: _______

FOR GIFT   Supply Gift Card Information. Use seperate sheet for each additional recipient. Distinguish each recipient by a unique "GIFT / Recipient ID" and indicate "Gift Wrap" $5.00 each or "Gift Bag" Free Message:____________________________________________              ____________________________________________      Apt#______________________   *Phone (Day): _________________ *Unlisted? ____   *Phone (Evening): ______________ *Unlisted? ____

Customer Surprise Specials ($6.00 grab bag) are also to be ordered here. http://www.AhBras.com/Customer_Surprise.htm
Catalog page# (ex: 2D)	Style# (ex: #20025)	Size (ex: S,M,L, 1+,3+,O/S, AVG,PLUS)	Style Name	GIFT / Recipient ID	Qty.	Price  Per Item	Total  Price
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Continued from first page - For additional items add additional page
Catalog page# (ex: 2D)	Style# (ex: #20025)	Size (ex: S,M,L, 1+,3+,O/S, AVG,PLUS)	Style Name	GIFT / Recipient ID	Qty.	Price  Per Item	Total  Price
_____	_______	_______	___________________	_____	_____	______	______
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Totals from all pages:
___________________ Specials & US Retail Bonus Awards, are based on US Retail prices before Handling & Service charges.				______	_____	_______	§  _______

Handling Charge: Handling Is $2.00 Per Item Add $4.00 if order is under $150.00 USD		Total Number of Items Ordered    $.75 each   $14.99 under  _______    $2.00 each   $15.00 & over  _______		§ Total    Retail USD		__________
§ SPECIAL BONUSES Based on Total US Retail Purchases Cash Credit is awarded on All Orders, Total US Retail of $200.00 or more,  may order an additional 10% more in Catalog items. (no specials)  IF The Retail amount of the ORDER is      $300.00 - $499.99     $100.00 free credit for only $8.00      $500.00 - $749.99     $160.00 free credit for only $8.00      $750.00 - $999.99     $230.00 free credit for only $8.00      $1000.00 or more:    $310.00 free credit for only $8.00 according to the Hostess program:         http://www.ahbras.com/ColHost.htm Plus may also order          "Customer Surprise Special"      The "Customer Surprise" Brochure and the "Be A Star Special" brochure may be found at:               http://www.AhBras.com/Customer_Surprise.htm				SUMMARY     § TOTAL         Retail(USD): _________________         TOTAL         Gift Wrap*: _________     *TOTAL         Handling: __________      *Mabel will pay the handling       charges for  handling over $38.50      for orders over $500.00 USD Retail.     Honored By Participating consultants only.
Total to be forwarded to TOTALS:    Handling:___________    Retail_____________   GiftWrap:__________