Get Bust Up Gum Order Form
Cash Only 20% Discount












E-Mail Address

































Add up all Item Amounts and enter result
in this box.
Must be over us$25.00.



Item(s) Total:


Enter Shipping Costs (from your PayPal Shopping
Cart) in this box.





Add Item(s) Total to Shipping costs and enter the
result in this box.
Subtotal = Items(s) Total + Shipping





Multiply Subtotal by .2 and enter the result
in this box.
This is your 20% Discount.
20% Discount = Subtotal x .2



20% Discount:


Subtract 20% Discount from Subtotal and enter the result in this box.
This is your payment. Cash only.  U.S. Dollars or Euro.
Total = Subtotal - 20% Discount





To order by mail (Cash payment only, if you are paying by check or money order this is not the correct order form):

  1. Complete the above form. Copy Item information, Item Amount(s), and Shipping costs from your PayPal Shopping Cart. If you have questions about how to complete this form, please contact me before you send your payment.
  2. Please send your payment (Cash Only in U.S. Dollars or Euro, do not send coins) for the Total amount. If necessary, use the Currency Converter located on the Get Bust Up Gum web site.
  3. Send this Get Bust Up Gum Order Form and your payment by Registered or Certified Mail to:

    PO BOX 530213
    HENDERSON, NV 89053-0213

I will ship your package to you one business day after I receive your payment.  You will receive a shipping confirmation by e-mail.  Please make sure you have included a working e-mail address on this form.

Thank you for your order!

Copyright 2005 - 2009 and CAD Consulting.  All Rights Reserved. Updated July 28, 2009.