LANGERS MERCHANDISE ORDER FORM
Print out form and mail it with your check made payable to: Langer Juice Company
DESCRIPTION 2T 3T 4/5 5/6 S M L XL TOTAL QTY. UNIT PRICE TOTAL
KIDS Apple T-Shirt *              $4.99  
KIDS Pear T-Shirt *           $4.99  
KIDS White Grape  T-Shirt *           $4.99  
  
Bear In The Big Blue House Cup Offer **      $2.99  
LANGERS MAGNET OFFER ***      FREE  
 
Number of Proofs of Purchase Enclosed         
. 

Check enclosed for $ ________________
(U.S. Dollars Only)
Total Amount Due
$_______________


* One Free T-Shirt for 10 kid's proofs of purchase OR $4.99 per T-Shirt plus 2 kid's juices proof of purchase.

** To receive your Bear Cup, complete and mail in order form along with 3 original UPCs from any Langers juices plus $2.99 and $1.00 for shipping and handling. Make your check or money order payable to Langer Juice Company. Allow 8-12 weeks for delivery. Offer void if original UPCs, complete mailing information or check or money order are not included.
 YES, I would like to receive additional information on Bear and Langers offers.

*** FREE with 4 proofs of purchase.

MAIL THIS FORM TO: DELIVER TO:
Langers Merchandise
c/o LANGER JUICE COMPANY
16195 Stephens Street
City of Industry, CA 91745