Order Form

Lifesucker

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Quantity Life Sucker™ ($7.99 each) . . . . . . . . . Total

_____/// For an adult smoker . . . . . . . . . . . . . . . . _____

_____/// For a teen smoker . . . . . . . . . . . . . . . . . _____

_____/// For an overeater. . . . . . . . . . . . . . . . . . . _____

_____/// For a stressed someone . . . . . . . . . . . . _____

_____///The Suckcess Method Booklet for Smoker ($5) . _____

_____///Preflavored KissStick ($7.99)

Anise (Black Licorice)____

Peppermint____

Spearmint_____

_____ Life Sucker™ Plastic Holder ($3 each). _____

_____Lorann Oils™ and Eyedropper ($3 each) _____

Indicate Quantity of Flavors Here

Anise____
Banana Cream _____
Bubblegum _____
Creme de Menthe _____
Orange _____
Peach _____
Peppermint_____
Root Beer _____
Pina Colada _____
Spearmint_____
Water Melon _____

Each Life Sucker™ comes in a plastic bag, but most prefer our holders as a convenient way to carry one Life Sucker™ and one bottle of Lorann Oil™.

Add $2.00 for shipping and handling of initial order of a Life Sucker™ and a Lorann™ oil. Add 50 cents for each additional oil or Life Sucker™.

__________ Order Total

+ ________ Tax (Colorado only. Multiply .073 x order total.)

+ ________ Shipping

__________ Grand Total

For schools and smoking cessation programs, a significant price-break is given for orders of 100 or more Life Suckers™.

If you are 14 or older and would like to become a Suckcessful Sucker Salesperson by selling Life Suckers™ over the web, please e-mail us.

For every 12 suckers sold, one Life Sucker™ is donated by Life Suckcess and one bottle of oil is donated by Lorann Oils™ to Denver Health and Hospitals for their Teenage Smoking Cessation Program.

Here are our different product covers, each are for different uses:

SHIPPING INFORMATION

Name ______________________________________

Address ____________________________________

City/State/Zip ________________________________

Telephone Number ___________________________

E-mail address _______________________________

THANKS!

Send Copy of Completed Order With Check or Money Order To:

Lifesuckcess L.L.C

1945 Locust St.

Denver, CO 80220





					Quantity Life Sucker™ ($7.99 each) . . . . . . . . . Total _____/// For an adult smoker . . . . . . . . . . . . . . . . _____ _____/// For a teen smoker . . . . . . . . . . . . . . . . . _____ _____/// For an overeater. . . . . . . . . . . . . . . . . . . _____ _____/// For a stressed someone . . . . . . . . . . . . _____ _____///The Suckcess Method Booklet for Smoker ($5) . _____ _____///Preflavored KissStick ($7.99) Anise (Black Licorice)____ Peppermint____ Spearmint_____ _____ Life Sucker™ Plastic Holder ($3 each). _____ _____Lorann Oils™ and Eyedropper ($3 each) _____ Indicate Quantity of Flavors Here Anise____ Banana Cream _____ Bubblegum _____ Creme de Menthe _____ Orange _____ Peach _____ Peppermint_____ Root Beer _____ Pina Colada _____ Spearmint_____ Water Melon _____ Each Life Sucker™ comes in a plastic bag, but most prefer our holders as a convenient way to carry one Life Sucker™ and one bottle of Lorann Oil™. Add $2.00 for shipping and handling of initial order of a Life Sucker™ and a Lorann™ oil. Add 50 cents for each additional oil or Life Sucker™. __________ Order Total + ________ Tax (Colorado only. Multiply .073 x order total.) + ________ Shipping __________ Grand Total For schools and smoking cessation programs, a significant price-break is given for orders of 100 or more Life Suckers™. If you are 14 or older and would like to become a Suckcessful Sucker Salesperson by selling Life Suckers™ over the web, please e-mail us. For every 12 suckers sold, one Life Sucker™ is donated by Life Suckcess and one bottle of oil is donated by Lorann Oils™ to Denver Health and Hospitals for their Teenage Smoking Cessation Program. Here are our different product covers, each are for different uses: SHIPPING INFORMATION Name ______________________________________ Address ____________________________________ City/State/Zip ________________________________ Telephone Number ___________________________ E-mail address _______________________________ THANKS! Send Copy of Completed Order With Check or Money Order To: