LIKE WATER BURNING
MERCHANDISE ORDER FORM
Please print this form and fill it out in pen.

Name _____________________________________________________________

Address ___________________________________________________________

City ___________________________ State ______________ Zip _____________

E-Mail_____________________________________________________________

All orders will be confirmed via E-mail once payment is received.

Like Water Burning Issue One

   Available Page Colors: Virgin White or Cream Pudding

Quantity _____ Page Color _____________ Price $______

Quantity _____ Page Color _____________ Price $______

------------------------------------------------SUBTOTAL $______

-------------------------------------------------- + shipping $______

------------------------------------------GRAND TOTAL $______

SHIPPING COSTS: Allow a maximum of 1-2 weeks for delivery.
US residents please include $3.00 for the first item, $1.00 for each additional item.
Canada/Mexico residents, add $4.00 first item, $1.00 each additional item.
International (outside N. America), add $5.00 first item, $1.00 each additional item.

Please mail this form with a money order or cash payable to:
Chad Tsuyuki

Chad Tsuyuki
109 Mira Mar Ave. #301
Long Beach, CA 90803

Questions regarding merchandise and ordering should be sent to:
likewaterburning@yahoo.com