Gold Stake Retail Order Form
4540 Post St., Suite 250 PMB #176 Phone: (800) 523-4653
El Dorado Hills, CA 95762 
Fax 916-941-2304
Quantity
Product No.
Description
Retail Price
Total
 
GS60
Gold Stake Mineral Supplement 60 Ct Bottle
26.25
 
 
GS60C
Gold Stake Mineral Supplement 12 Bottles per case - 60 Ct Bottle
315.95
 
 
GS125
Gold Stake Mineral Supplement 125 Ct Bottle
41.95
 
 
GS125C
Gold Stake Mineral Supplement 12 Bottles per Case - 125 Ct Bottle
502.95
 
 
GSP1
Gold Stake Mineral Bulk Powder 1 oz. Bottle
40.95
 
 
GSP1C
Gold Stake Mineral Bulk Powder 12 Bottles per Case - 1oz. Bottle
490.95
 
 
P7120
Product 7 Herbal Formula 100 Ct Bottle
24.95
 
 
P7120C
Product 7 Herbal Formula 12 Bottles per Case - 100 Ct Bottle
301.75
 
 
SALVE
Gold Stake Mineral Salve 2 oz. Jar
41.95
 
 
WGEL4
Willared Ge'loe 4 oz. Tube
18.95
 
 
WW1G
Willard Water 1 Gallon Bottle
157.49
 
 
WW8
Willard Water 8 oz. Bottle
28.29
 
 
WW4
Willard Water 4 oz. Bottle
19.95
 

Credit Card Name:________________________________
Credit Card Number:______________________________
Expiration Date: _________________________________
SUB -TOTAL
SHIPPING AND HANDLING
TOTAL AMOUNT DUE
 
 
 
Print Name of Purchaser on this Line:___________________________________________________________
Address:________________________________________
Phone:__________________________________
City:___________________________________________
State:___________________________________
Retail Sales Tax Number:____________________________
(not required outside California)
Zip Code:________________________________
1.5% interest per month charged on accounts past due over 30 days
For all Credit Card Sales, Call (800) 523-4653