U.S. Order Form

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 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:
Quantity	Description (variety, size, weight)	Item Price	Total Cost










	Merchandise Total
Fresh Orders: USA ONLY	Orders that include Kefir, Viili, Fil Mjolk, Seed Miso, Kombucha, Rice or Rye Sourdough, Cool Rise or Cultured Crepe. Any order with 1 or more of these: $12.00. See directions at: U.S. Orders	Shipping- $12.00 (Covers all items in the order.)
Dry Orders:	Those orders that do not include Fresh Cultures: $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 Orders, use chart at left.
Payment:	Send Check or Money Order, with written order to: GEM Cultures, Inc. PO Box 39426, Lakewood, WA 98496 ORDER TOTAL: