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Complete the form below, print it and post with cheque, cash or PO Money Order to:

Northern Web Technologies CMB 19 PO Box 509 VIRGINIA NT 0822 AUSTRALIA

Fill in the form, print it, then post it with your payment to the above address

First Name:

Last Name:

Bottled Kombucha Tea (Australia Only) 3 x 750 ml bottles $28.40
........ Quantity =

1 x Kombucha Culture shipped in Australia $20
(if paying by money order or cash $15) ....................Quantity =

3 x Kombucha Culture Shipped in Australia $40
(if paying by money order or cash $30) ....................Quantity =
(Buy 2 and receive a 3rd Kombucha Culture FREE offer for Australia only)

1 x Kombucha Culture Shipped Worldwide $ 35 ..... Quantity =

Shipping Address:

City:

State/Territory:

Postcode:

Phone:

Email:

Once payment is received a fresh Kombucha Culture will be posted immediately your shipping address.

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