DATE_____________

Shipping Address :

Name__________________________________________________________________

Address_______________________________________________________________

City________________________ State_________________ZIP________________

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ITEM	UNIT PRICE	QUANTITY	ITEM	UNIT PRICE	QUANTITY
Yu Xiao San 8805	$40.00	b.	Yu Xiao San 8804	$25.00	b.
For Her 1-2-3	$40.00	b.	New Feeling	$15.00	b.
Kidney Purifier 1-2-3	$30.00	b.	Brain & Heart 1-2-3	$25.00	b.
Eye Bags Away	$25.00	b.
Breath 1-2-3	$25.00	b.	Subtotal	$
Pain Away 1-2-3	$25.00	b.	Shipping	$
Slim 1-2-3	$25.00	b.	Total	$