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Type information directly into the form below. Print a copy of the completed form on your printer before going to the next page. Keep the copy for your records. At this time credit card payments are received through Paypal.com only. Allow two weeks from the receipt of payment for delivery. If there is any problem, you will be notified or your payment will be returned. Please, do not send cash. ( * required information.)

First Name
*

Last Name
*

Address
*

City
*

State
*

Zip
*

Country
*

Phone Number
*

Email Address
*

Quantity Items Price Amount

Solar Power Fountain -- In stock
$79

Insured shipping - US Postal Service Global Priority
$15

Total

Thank you for your interest in Pratique.


	First Name	*
	Last Name	*
	Address	*

	City	*
	State	*
	Zip	*
	Country	*
	Phone Number	*
	Email Address	*

Quantity	Items	Price
	Solar Power Fountain -- In stock	$79
	Insured shipping - US Postal Service Global Priority	$15
Total

Complete and print this form

First Name * Last Name * Address * City * State * Zip * Country * Phone Number * Email Address * Quantity Items Price Amount Solar Power Fountain -- In stock $79 Insured shipping - US Postal Service Global Priority $15 Total

Thank you for your interest in Pratique.

First Name
*

Last Name
*

Address
*

City
*

State
*

Zip
*

Country
*

Phone Number
*

Email Address
*

Quantity Items Price Amount

Solar Power Fountain -- In stock
$79

Insured shipping - US Postal Service Global Priority
$15

Total