SobrityWorks247.com                                Order Form  Pay by Check Ship to: Name: _________________________________       Phone #: (____)____________________ Street Address:_________________________ City:_____________________ State:________ Zip code:____________      Email : ___________________________________                                  Description                                           | QTY | ITEM PRICE | AMOUNT                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                                                                                               |          |                        |                 Mail this form to:                                                                     Subtotal:______________                Sobriety Works                                                                      Shipping:______________       1333 Ridgeview Circle       Downingtown Pa. 19335                                                       Grand Total:______________                                                                                                 Shipping Prices       Web Site: www.SobrietyWorks247.com              (based on cost of merchandise)       E-mail: Sobrietyworks@verizon.net                                                                                            $0 to $39.99 ------------$4.50                                                                                   $40 to $69.99 ---------- $7.55                                                                                   $70 to $99.99 ---------- $10.75                                                                                   $100 and up ------------ $13.50