Ordering Light-Free Smokeless Cigarettes is easy! To pay by check, simply fill out this form, print it and mail it to us with your check.

Remember to add the $4.95 for shipping/handling.

Please make checks out to: Grand Works

Our address is:

Grand Works 1844 N. Nob Hill Road - #304 Ft. Lauderdale, FL 33322

Upon receipt of your order, we will ship the product to you within 10 days. With our product, you get a 60 day 100% satisfaction guarantee! That means, if you are not completely satisfied with Light-Free Smokeless Cigarettes within the first 60 days, we will give you your money back! See Our Guarantee!

Shipping Information
First Name:	Last Name:
Street Address:	Additional Address Information:
City:	State:
ZIP Code:	Country:
Daytime Telephone:	Evening Telephone:
E-mail Address:
Billing Information
	Same As Shipping
First Name:	Last Name:
Street Address:	Additional Address Information:
City:	State:
ZIP Code:	Country:
Daytime Telephone:	Evening Telephone:
E-mail Address:
Please choose the product(s) you would like to purchase:
Product	Quantity	Price	SH
1 Month Supply	0 1 2 3 4 5	$24.95	$4.95
2 Month Supply	0 1 2 3 4 5	$39.95	$4.95
3 Month Supply	0 1 2 3 4 5	$59.95	$4.95

Mail To:
Grand Works
1844 N. Nob Hill Road - #304
Ft. Lauderdale, FL 33322
Please make your check out to: Grand Works

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