Name:


Just print, fill out, and mail or fax this order form!


BeticBag
1308 Bruton Springs Road
Austin, TX 78733

Fax: 512.402.1089

Address 1:
Address 2:
City/State/Zip:
Country:
Area code/Phone:
E-mail:
Choose bags:
Bag Price Quantity desired
men's fashion accessories, day planner organizer leather case diabetic supply kit High Profile $74.95
women's fashion accessories, day planner organizer leather case diabetic supply kit Stylized Trifold $70.95
teenager and gir's fashion accessories, day planner organizer animal print case diabetic supply kit Hot-Looking Zebra $24.95
boy's kids' fashion accessories, day planner organizer dinasaur picture pattern case diabetic supply kit 3-D Dinosaurs $32.95
girl's kids' fashion accessories, day planner organizer flower butterfly pattern case diabetic supply kit 3-D Butterfly Garden $32.95
UPS (3 days) ground: $10.00
USPS Priority overnight: $20.00
USPS International: $20.00

Total price:
Credit card #:
Exp. date:
Signature:

© Copyright 2006 BeticBag. Stylish bags and cases for diabetic supplies.