Synertek Colostrum Mail-Order Form

To order by mail, print this form, fill out with pen or pencil, and send with a check or money order to:

                    Synertek Colostrum, Inc.
                    6919 Pasadena Drive
                    Cheyenne, WY 82009

I would like to order the following number of each:

____ Bottles of 1st six hour colostrum lozenges, $19.95 each, $16.95 each for four or more bottles,
         100 lozenges per bottle.          

____ Four ounce bottles of 1st six hour liquid colostrum, $29.95 each.

____ 250 grams (.55 pounds) of pure, uncut, highest quality 1st six hour colostrum powder,
         $59.95 each.

Total cost of order:

                                Amount of order: $______________
                  Plus shipping, priority mail:               $6.00                                      

                                                  Total: $______________  

Please ship to:
                                                                                                                         
__________________________________     _______________________________
Name   (first)                      (last)                                      Street Address

__________________    __________    _____________   (_____)_______________
City                                       State               Zip Code                 Telephone (optional)

Email Address (optional)_____________________________________