CLUBDRI Mail-in Order Form

Print this form, fill out the information, then mail to:

Baker & Rose, LLC
3005-B South Memorial Dr.
Greenville, NC 27834
Product Description
Quantity
Price (ea.)
Add
S&H
Total
CLUBDRI System - Introductory Price
(includes pouch, fill, re-fill, 2 buddies, instructions)
$34.99
$8.95
$
CLUBDRI Pouch  
$29.99
$6.95
 $
HANDDRI by CLUBDRI
$ 7.99
$3.95
$
CLUBDRI re-fill (5 oz.)
$9.99
$4.95
$
Sales Tax (7% NC Residents Only)
Grand Total
$
$
Payment Information
Enclosed: Money Order    Personal Check (15-day waiting period)
Credit Card: Master Card   Visa   Amex   Discover
Full Name on card: ____________________________________________
Account Number ____________________________________________ Exp. Date:_________
Signature: ____________________________________________
   
Delivery Information
Name: ____________________________________________
Address: ____________________________________________
City: ____________________________________________ State: ____ Zip:_______
Phone: (_____)____________________ Other: (_____)____________________
E-mail: ____________________________________________

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