Instructions:

  1. Print out this order form

  2. Complete form (please print as clearly as possible)

  3. Include daytime phone number in case we have any questions

  4. Please include check or money order payable to Papa Juice.

  5.  Note: For faster delivery, send certified check or money order. 

  6. Personal checks must clear before product is shipped.

  7. Mail to address below

Papa Juice
P O Box 1320
Hayward, WI  54843

Name:_____________________________________

Shipping Address:  _________________________________________

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City:___________________________  State:_____   Zip:___________

Daytime Phone Number (Important): (_____) - _____ - _________

I would like to order:

_____ 1 bottle of Papajuice Unscented Hand & Lure Cleaner at $4.95 (price includes tax and shipping)

_____ 1 bottle of Papa Juice at $5.95 (price includes tax and shipping)

_____  2 bottles of Papa Juice at $9.95  (price includes tax and shipping)

Check which formula you would like:

____Trout ____ Steelhead     ____Bass     ____Crappie      ____Walleye

____Salmon____Muskie____Northern____Panfish______Extreme Ice Fishing Stimulant

If paying by credit card please provide:

Credit Card Number: ________ - ________ - _________ - _________

Card Type:  ___Visa   ___MC  ____Other

__________________________________________________
Signature

Questions or Comments:__________________________________________

_____________________________________________________________

_____________________________________________________________

Thank you for your order!