U.S. Order Form

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GEM Cultures, Inc. PO Box 39426 Lakewood, WA 98496, USA		Date:
Name
Shipping Address:	Please provide the street address or PO Box, wherever you receive USPS mail. For orders including Fresh Cultures, provide phone number or e-mail address so we can tell you when to expect your order.
Address:
City:	State: Zip:
Phone:	Email:
Notes: 1.	Extreme Heat or Freeze will cause shipping delays for Fresh Cultures, as these are LIVE Cultures. (See Home Page)
2.	Due to High Demand there is limit of 20 kits (any variety) per order.
Quantity:	Description (variety, size, weight)	Item Price	Total Cost








		Subtotal:
Shipping FRESH:	Any orders that include Kefir, Viili, Fil Mjölk, Seed Miso, Kombucha, Sourdough, Cool Rise or Cultured Crepe add $12.00 shipping. See directions at: U.S. Orders	Shipping: $12.00 (Covers Fresh and Dry goods in the order.)
Shipping DRY GOODS ONLY:	Orders that do not include Fresh Cultures use chart below: $0 to $5.00..............$3.00 $36.01 to $44.00.....$8.00 $5.01 to $10.00.......$4.00 $44.01 to $52.00.....$9.00 $10.01 to $20.00.....$5.00 $52.01 to $60.00.....$10.00 $20.01 to $28.00.....$6.00 $60.01 to $70.00.....$11.00 $28.01 to $36.00.....$7.00 $70.01 and over.....$12.00	Shipping: (Dry Goods)
Payment:	Send Check or Money Order, with written order to: GEM Cultures, Inc. PO Box 39426, Lakewood, WA 98496	ORDER TOTAL: