Please Print this form out and mail to:
Mel Stanley & Co.
2544 North 1500 West
Clinton, Utah 84015
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Attention Belt, Arm Band Number Holder and  Accessories Order Form
Waist Attention Belt Package Qty; _____;
(Must Include Waist Size) __________________Price $25.00

Arm Band Number Holder Package Qty  ______;
(Must Include Upper Arm Size) __________      Price $25.00


The above 2 Packages include the waist, or the arm band number holder, 6 bait sticks, and a plastic tab.

When measuring , be sure and measure over sweat shirt or clothing you normally wear when training


Replacement Bait sticks ______________ 6 for $6.50

Replacement Plastic Tab ______________$2.50


Add Postage;                                $5.00

Amount Enclosed: ________________________(Currently we only accept checks or Money Orders)


Name;_________________________________________

Address: _________________________________________

City: ______________________ State: ________ Zip: _______

Phone: ( _ _ _ ) _ _ _ - _ _ _ _

E-Mail:;___________________________________________________________

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