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            (TO PRINT OUT AN ORDER FORM....simply type the letter P
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                            LONGLASTINGS ORDER FORM
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    SEND ORDER TO: LongLastings, PO Box 519, Coupeville, WA  98239-0519

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    SHIP TO--NAME:___________________________________DATE:_______________

    STREET AND/OR PO BOX:________________________________________________

    CITY:_________________________________STATE:________ZIP:_____________

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    ITEM # |    DESCRIPTION OF ITEM    | QUANTITY | PRICE/EACH |  TOTAL
    =====================================================================
    KM224  | Kombucha                  |          |      49.95 |
    _______|___________________________|__________|____________|_________
    WL290  | FIT & TRIM YOU Weight Loss|          |      47.95 |  
    _______|___________________________|__________|____________|_________
    ES0045 | Essiac Herbal Mixture     |          |      35.00 |
    _______|___________________________|__________|____________|_________
    8501   | Quick M Capsule Filler    |          |      12.95 | 
    _______|___________________________|__________|____________|_________
        SHIPPING INFORMATION                MERCHANDISE TOTAL  |_________
    Order Total-------------ADD             WA RESIDENTS ADD 6%|_________
    Up to $20.00-----------$3.95         SHIPPING (See Chart)  |_________
    $20.01-$35.00----------$4.95     25% Dealership Discount - |_________
    $35.01-$50.00----------$5.95        TOTAL AMOUNT ENCLOSED  |_________
    $50.01-$75.00----------$7.50  
    Over $75.00------------$9.50
    Foreign Orders add $4.95 to any shipping price above.

Circle Payment Method: Check  |  Money Order  | Master or Visa card |
                       /\                 /\
                       ||_U.S. Funds Only_||

MASTER/VISA CARD:_____ Card#, Expiration Date, and Signature Required.

Card#:____________________Expires |_____|_____| Signature:_____________________

SHIP TO-> NAME:______________________________________________DATE:_____________

ADDRESS:_______________________________________________PHONE#:_________________

CITY/STATE/ZIP:________________________________________________________________

Where did you get this program?________________________________________________

                     * * * THANK YOU FOR YOUR ORDER * * *