SUPER GEL PRODUCTS PRINTABLE MAIL/FAX ORDER FORM

NAME:____________________________________   ADDRESS:________________________________

CITY:____________________   ST:____   ZIP:_______-____

PHONE: (___)___________   FAX: (___)___________   EMAIL:_________________________

CARD NUMBER:_____________________________   EXP:_________

ALL ITEMS ARE SHIPPED VIA UPS. WE DO SHIP TO P.O. BOXES.
Item # Product Description Price Qty Total
EGG-01  Egg-Cerciser   1 lb $ 8.00   _____ _____
LL-01  Magic Lint Lifter (3 Pack) 1 lb $ 6.50   _____ _____
WL-01  Wrist Lifter   1 lb $ 9.00   _____ _____
GT-01  Giant Gel Balloons (2 Pack) 1 lb $ 10.50   _____ _____
GT-02  Gel Reptiles (2 Pack) 1 lb $ 8.50   _____ _____
GBS-01  Hybrid Bike Seat Pad   2 lb $ 16.50   _____ _____
GBS-02  Cruiser Bike Seat Pad   3 lb $ 26.50   _____ _____
GBS-03  Exerciser Bike Seat Pad   4 lb $ 35.50   _____ _____
GSS-01  Stadium Seat   3 lb $ 39.50   _____ _____
GSW-01  Wheelchair Seats   6 lb $ 79.00   _____ _____
PBS-01  Pals Beauty System   2 lb $ 42.50   _____ _____
PBS-02  Pals Beauty Oil   4 oz $ 11.50   _____ _____
PBS-03  Pals Beauty Gloves   1 lb $ 18.50   _____ _____
PBS-04  Pals Beauty Socks   1 lb $ 18.50   _____ _____
AN-01  Attachable Nipples - Tan (1 Pair) 3 oz $ 7.50   _____ _____
PCH-01  PALS Carrying Pouch   5 oz $ 11.50   _____ _____
P-01  PALS Push-Ups - no nipple (B Cup) Nude 1 lb $ 19.95   _____ _____
PN-01  PALS Push-Ups with nipples (B Cup) Nude 1 lb $ 29.95   _____ _____
PN-04  PALS Push-Ups with nipples (B Cup) Natural 1 lb $ 29.95   _____ _____
RD1-01  PALS Raindrops with nipples (B Cup) Nude 2 lb $ 49.95   _____ _____
RD1-04  PALS Raindrops with nipples (B Cup) Natural 2 lb $ 49.95   _____ _____
RD2-01  PALS Raindrops with nipples (C Cup) Nude 2 lb $ 59.95   _____ _____
RD2-04  PALS Raindrops with nipples (C Cup) Natural 2 lb $ 59.95   _____ _____
RD3-01  PALS Raindrops with nipples (D Cup) Nude 2 lb $ 69.95   _____ _____
RD3-04  PALS Raindrops with nipples (D Cup) Natural 2 lb $ 69.95   _____ _____
TD1-01  PALS Teardrops with nipples (B Cup) Nude 2 lb $ 49.95   _____ _____
TD1-04  PALS Teardrops with nipples (B Cup) Natural 2 lb $ 49.95   _____ _____
TD2-01  PALS Teardrops with nipples (C Cup) Nude 2 lb $ 64.95   _____ _____
TD2-04  PALS Teardrops with nipples (C Cup) Natural 2 lb $ 64.95   _____ _____
TD3-01  PALS Teardrops with nipples (D Cup) Nude 3 lb $ 79.95   _____ _____
TD3-04  PALS Teardrops with nipples (D Cup) Natural 3 lb $ 79.95   _____ _____
TD4-01  PALS Teardrops with nipples (DD Cup) Nude 3 lb $ 99.95   _____ _____
TD4-04  PALS Teardrops with nipples (DD Cup) Natural 3 lb $ 99.95   _____ _____
TRS1-01  PALS Triangles with nipples (32-36 TRS1) Nude 2 lb $ 49.95   _____ _____
TRS1-04  PALS Triangles with nipples (32-36 TRS1) Natural 2 lb $ 49.95   _____ _____
TRS2-01  PALS Triangles with nipples (32-38 TRS2) Nude 2 lb $ 59.95   _____ _____
TRS2-04  PALS Triangles with nipples (32-38 TRS2) Natural 2 lb $ 59.95   _____ _____
TRS3-01  PALS Triangles with nipples (32-40 TRS3) Nude 3 lb $ 69.95   _____ _____
TRS3-04  PALS Triangles with nipples (32-40 TRS3) Natural 3 lb $ 69.95   _____ _____
TRS4-01  PALS Triangles with nipples (32-42 TRS4) Nude 3 lb $ 79.95   _____ _____
TRS4-04  PALS Triangles with nipples (32-42 TRS4) Natural 3 lb $ 79.95   _____ _____
TRS5-01  PALS Triangles with nipples (34-44 TRS5) Nude 3 lb $ 99.95   _____ _____
TRS5-04  PALS Triangles with nipples (34-44 TRS5) Natural 3 lb $ 99.95   _____ _____
TRL1-01  PALS Triangles with nipples (36-46 TRL1) Nude 3 lb $ 89.95   _____ _____
TRL1-04  PALS Triangles with nipples (36-46 TRL1) Natural 3 lb $ 89.95   _____ _____
TRL2-01  PALS Triangles with nipples (36-48 TRL2) Nude 4 lb $ 119.95   _____ _____
TRL2-04  PALS Triangles with nipples (36-48 TRL2) Natural 4 lb $ 119.95   _____ _____
TRL3-01  PALS Triangles with nipples (38-50 TRL3) Nude 4 lb $ 149.95   _____ _____
TRL3-04  PALS Triangles with nipples (38-50 TRL3) Natural 4 lb $ 149.95   _____ _____
TRL4-01  PALS Triangles with nipples (40-52 TRL4) Nude 5 lb $ 179.95   _____ _____
TRL4-04  PALS Triangles with nipples (40-52 TRL4) Natural 5 lb $ 179.95   _____ _____
7.75% Ca Tax _____
ONLY $10.00 SHIPPING AND HANDLING PER ORDER, REGARLESS OF QUANTITY FOR DOMESTIC ORDERS. INTERNATIONAL ORDERS ARE A FLAT $30.00 PER ORDER FOR SHIPPING AND HANDLING. Shipping $10.00
Total _____
NOTE: Pals may be EXCHANGED within 30 days if and only if the individual bags have not been opened. No refunds !
 SPECIAL NOTE: Latex clothing will ruin the pals product. Do not use this product with any latex or latex-based clothing or garments.
Also, wash any black garments or materials before using the pals product since the dyes will run and stain this product
 MAIL TO: SUPER GEL PRODUCTS 1784 Container Circle Riverside, CA 92509
PHONE: 951-222-2230 FAX: 951-680-0976 TOLL FREE: 866-922-7257