Order Form

Grandma Dot, LLC
a division of Berlaine Enterprises, LLC

Because public toilets are too big and too dirty for your toddler.

ORDERING DIRECTLY FROM GRANDMA DOT

ZEETS™ ORDER FORM

NAME:

SHIPPING ADDRESS:

CITY: STATE/PROV:

ZIP/POSTAL CODE:

TELEPHONE:

E-MAIL ADDRESS:

Number of Boxes of ZEETS™: ($12.99 each, less any specials)

CALL WITH SHIPPING & TOTAL UNLESS THIS BOX IS CHECKED (If checked, proceed to calculate shipping and compute total without calling):

MESSAGE, QUESTIONS OR COMMENTS (Including Specials):

CREDIT CARD INFO (Mastercard and Visa Only, please):

Card Number:

Billing Address, if different from above:

Expiration Date: / Three Digit Code on Back of Card:

OR: Call the phone number(s) provided for credit card information

ZEETS™ are $12.99 per box of 5, less any promotions or specials, plus shippping.|

We do not have an on-line store through which to order and which automatically bills your credit card. To order from us directly you have the following options:

1. Call us. We will take your order over the phone or call you back promptly. our telephone number is
(818) 981-1779 or, toll-free at 1-866-Go Zeets (1-866-469-3387)

2. E-mail us at: sales@grandmadot.com

3. Use the form below. It creates and sends us a formatted e-mail. We will manually process credit card information provided, or call you for the information (your choice).