Breakfast With Mimi Mail-In Order Form
Print Out - Fill Out - Mail In (US Funds Only)

• Send me _____  Breakfast With Mimi @ $9.95
• $ ____________ Total Cost of Books Ordered
• $ ____________ Shipping & Handling for each piece ordered ($4.50) -- (Canada $10.50) (Europe-UK $20.00)

Total: ________________

• Send me _____  Breakfast With Mimi and Diamond Hearts Bracelet Special @ $99.95
• $ ____________ Total Cost of Special Package Ordered
• $ ____________ Shipping & Handling for each piece ordered ($4.50) -- (Canada $10.50) (Europe-UK $20.00)

Total: ________________

• Send me a second  Breakfast With Mimi and Diamond Hearts Bracelet Special for someone in the Armed Forces @ $49.95
• $ ____________ Total Cost of Special Package Ordered
• $ ____________ Shipping & Handling for each piece ordered ($4.50) -- (Canada $10.50) (Europe-UK $20.00)

Total: ________________

______________________________________________

Name: ___________________________________________________________

Address: __________________________________________________

City: _____________________________________________________________

State: _______________________________________ Zip Code: _____________

Mailing Address (if different): _________________________________________

Phone (Days): ____________________ Phone (Eves): ______________________

e-mail Address: ___________________________________________________

Special Instructions:________________________________________________

Select Payment Type: (include payment with form)

Check Payment Type: _____Cashiers _____ Money Order _____ Certified Check
_____ Personal Check _____ PayPal*
Check Number: __________ (personal checks need to clear our bank before order is shipped)

Make checks payable to: Tom Gregg

Mail Order Form To:

Breakfast With Mimi
c/o Tom Gregg
18553 Olalee Way
Apple Valley, CA 92307