Retail Order Form for U.S. Customers

(Highlight and print)

Name __________________________________________________

Street Address __________________________________________

City ____________________________________________________

State __________________________________________________

Zip ____________________________________________________

Telephone _____________________________________________

Email _________________________________________________

Ordering Instructions: Print the order form, add the products you want,  and complete the above order form.  Mail order form with a personal check, cashiers check, or money order to the following address:  Jennifer Tarver, 2103 Lanier Dr,  Winnsboro, LA 71295.

Note: Personal checks must clear before order is shipped. 

Miracle-II Products are shipped by the U.S. Postal Service & UPS Ground.  Please include your telephone number with your order in case we need to contact you about your order.