Special Diets Resource Guide Order Form
Please fill in all areas of the form.  You can type in the form and then print it out - or - print first and then fill in the form by hand. Mail with payment to the address at the bottom. Please contact Customer Service with any questions regarding ordering procedures.
SHIPPING ADDRESS
Name
Address

City

State

Zip Code

Phone

BILLING ADDRESS
Check if same as Shipping Address.  
Name
Address

City

State

Zip Code

Phone

E-mail 

Please check if you would like e-mail confirmation of your order and shipping status.
Item QTY Price Each Total Price
Silly Yak Pack Lunch Box Cooler $16.99

Reusable Freezer Ice Pack $1.60
    ORDER TOTAL:
Shipping:
Purchase includes FREE SHIPPING via 2 day USPS Priority Mail. Orders will be shipped within one business day. An e-mail confirmation will be sent to notify order has been accepted and processed.

Customer Service:

  • Phone: 1-877-475-4677
  • E-mail: support@specialdiets.org
Credit Card Payment:
Visa MasterCard AmEx Discover
Card Number:
Expiration: / CVV2 #:
Name on Card:
To pay by check or money order in U.S. funds:

Make payable to: Sunni Mullis
Print and mail form with payment to:
Special Diets Resource Guide Orders
P.O. Box 57062
Jacksonville, FL 32241