Fiedler's Cambridge, Kitchener/Waterloo, ON Canada Email: email@example.com / www.fiedlershopping.com Order No. ORDER FORM Customer Name Address City Phone Misc Date Province P Code Qty Description Community Program started on February 25, 2009 Organic Combo Pack* consists of: 1a. One Organic Bamboo and Cotton T-Shirt for ladies OR (Three styles available and it will be a nice surprise as to which one you will receive in the combo pack.) Unit Price $ 35.00 $ TOTAL - Choices of Size: S, M, L and XL 1st Choice: 3rd Choice: 2nd Choice: 4th Choice: 1b. One Organic Cotton Long-Sleeve T-Shirt for men (Three styles available and it will be a nice surprise as to which one you will receive in the combo pack.) Choices of Size: S, M, L, XL and XXL 1st Choice: 3rd Choice: 2nd Choice: 4th Choice: 5th Choice: 2. One Organic Green Chai (25 tea bags/retail box) 3. One Organic Grey Earl (25 tea bags/retail box) Giving Back $5.00 per pack sold to be donated to a non-profit/charity group Be sure to email your preferred non-profit/charity group to us. Fiedler's will donate the collected funds to the group with the highest vote. Tax receipt to be posted on the website. * Limited offer and subject to availability. Sorry - no backorder. ** For Ontario customers, $5.99 for one set | $7.99 for two sets | $9.99 for 3-4 sets (Canada Post Regular Parcel Service). SubTotal $ **Shipping and Handling Fee (to be advised by Fiedler's upon receipt of your order) Other PST 8.00% Special - N/A GST 5.00% Total excl S&H $ You will receive an email from Fiedler's with Paypal payment instructions. Office Use Only: Payment Special instructions for the Organic Bamboo Cotton T-shirt: Machine wash cold, hang dry for best results. Warm iron as needed. To prevent staining, remove from hanger before steaming any wrinkles.