U.S. Order Form

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Note: If you are unable to Print this order form, please include, on a piece of paper, all of your contact information requested on the form with a list of the items you would like. Send it, with your check or money order, to the address on the form. Thank you!

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GEM Cultures, Inc. PO Box 39426 To use PayPal or Zelle, email us at: Lakewood, WA 98496, USA gemculture@juno.com		Date:
Name
Shipping Address:	Please provide the street address or PO Box, wherever you receive your 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:
Please Note:	Extreme Heat or Freeze will cause shipping delays for Fresh Cultures, as these are LIVE Cultures. (See Home Page)
Please Include:	Koji variety and size: Light, Red, Barley, Soy or Shoyu Kit 15g or Commercial 40g or 60g. Natto size: Kit 11g or Commercial 3g (pure spore). Fermentation Cloth Cover color: Royal, Red, Black, Gray, Green, White or Navy. Super Sealer Lid size: Standard or Wide Mouth.
Quantity	Description (Include: Variety, Size, Weight)	Item Price	Total Cost









	Merchandise Total
Shipping FRESH:	Cultures shipped with Cold Ice Pack : Any order with 1 or more of these cultures: Kefir, Viili, Fil Mjölk, Seed Miso, Kombucha, Sourdough, Cool Rise or Cultured Crepe add $16.00 shipping. See directions at: U.S. Orders	Shipping: $16.00 (Covers all items in the order.)
Shipping DRY GOODS ONLY:	Orders that do not include Fresh Cultures use chart below. (These are shipped by either First Class or Priority mail.) $0 to $10.00............$6.00 $70.01 to $80.00.....$13.00 $10.01 to $20.00.....$7.00 $80.01 to $90.00.....$14.00 $20.01 to $30.00.....$8.00 $90.01 to $100.00.....$15.00 $30.01 to $40.00.....$9.00 $100.01 to $110.00....$16.00 $40.01 to $50.00.....$10.00 $110.01 to $120.00....$17.00 $50.01 to $60.00.....$11.00 $120.01 to $130.00....$18.00 $60.01 to $70.00.....$12.00 $130.01 and up.........$19.00	Shipping
Payment:	For Pay Pal or Zelle, email gemculture@juno.com or Send Check or Money Order, with written order to: GEM Cultures, Inc. PO Box 39426, Lakewood, WA 98496	ORDER TOTAL: