Kombucha Products Order Form


Please print page, fill in form, and mail with check or money order
(payable to H.D. Brown) to:

H.D. Brown/kombucha
PO Box  204
Massena, NY 13662

Name: ______________________________________________

Address:____________________________________________

City:_________________________ State/Country:___________

Zip/Country code:__________

Quantity: -------------------- Item: -------------------------- price ------------- Total(s)

______ 2 Kombucha Cultures & Instructions ------- $15.00 ---------- ________

Above price includes shipping and handling within continental U.S. via
U.S. Postal Priority Mail.


Additional Shipping for orders outside continental U.S. ----------- $15.00 - ________

----------------------------------------------------------------------------Total _________

Orders will be shipped U.S. Postal Priority Mail (other if checked, with payment enclosed)



E-mail: ________________

Phone #: _______________

Additional instructions/comments: