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                                                                                                                                                                   Send orderS to:                                            Send returnS/exchangeS to:
 a      sold to                                                                                                                                                    gaiam                                                      gaiam, inc.
        (if name or address is incorrect, please correct it below)                                                                                                 po box 3095                                                5455 West chester rd.
                                                                                                                                                                   boulder, co 80307                                          West chester, oh 45069
customer no.                                 key code


                                                                                    order by phone                             order online                              contact customer service                                            o r d e r b y fa x



                                                                                    877.989.6321                                gaiam.com                                         877.989.6321                                           800.456.1139
                                                                                                                                                                                 w e e k d ay s   9am ­ 9pm       est or                      be sure to include
                                                                                             24   hours
                                                                                                                                                                                 customerservice @ gaiam . c o m                      pay m e n t i n f o   &   phone number


phone no. (                      )____________________________________
                                                                             ship                                                                                                                                            gift                    item
Visit gaiam.com/signup to receive exclusive e-mail offers and news about                     item #        Qty             product description                                 size                    color                                                             t o tA l
                                                                              to                                                                                                                                             box                    price
sales and discounts.
                                                                              A b

                                                                              A b

                                                                              A b
  B     s h i p t o (if different from A)            this is A gift           A b

                                                                              A b

                                                                              A b
name
                                                                              A b
Address
                                                                              A b
city
                                                                              A b
state                              zip                                        A b

gift message:                                                                 A b

                                                                              A b             37-0000                                Go Zero                                    ----                      ----                ----                    $2.00


                                                                           pAy m e n t i n f o r m At i o n                                 s h i p p i n g & h A n d l i n g per address                                  Merchandise Total
                                                                           cash and credit card checks are not accepted.                    s u b t o ta l                                        charge
                                                                                                                                                                                                                           Add: $5 for each gift box
                                                                                                                                            up to $25.00. . . . . . . . . . . . . . . . . . . . . . . . . $5.95
                                                                             check # __________________________
                                                                                                                                            $25.01­$50.00 . . . . . . . . . . . . . . . . . . . . . . . $7.95
                                                                             money order # __________________________                                                                                                      Subtotal
                                                                                                                                            $50.01­$70.00 . . . . . . . . . . . . . . . . . . . . . . . $9.95
                                                                             gift certificate # __________________________                  $70.01­$100.00 . . . . . . . . . . . . . . . . . . . . . $11.95
  C     s h i p t o (if different from A)            this is A gift          American express
                                                                                                                                            $100.01­$125.00 . . . . . . . . . . . . . . . . . . . . $13.95
                                                                                                                                                                                                                           Add: shipping & handling
                                                                                                                                                                                                                           charges per address
                                                                                                                                            $125.01­$150.00 . . . . . . . . . . . . . . . . . . . . $14.95
                                                                             Visa                                                           $150.01­$180.00 . . . . . . . . . . . . .10% of subtotal                       Add: rush shipping charges
                                                                             mastercard                                                     $180.01­$200.00 . . . . . . . . . . . . . .9% of subtotal                      per address
name                                                                                                                                        $200.01+ . . . . . . . . . . . . . . . . . . . .8% of subtotal
                                                                             discover card                                                                                                                                 Add: oversize shipping charges
                                                                                                                                            call for rates to AK, hi, u.s. territories & canada.
Address                                                                    credit card no.                                                                                                                                 per item (amount listed in
                                                                                                                                                                                                                           parentheses after price)
                                                                                                                                            r u s h s h i p p i n g must call by 12:30 p.m. est
city
                                                                                                                                            rush charge is in addition to regular shipping charges.                        Add: sales tax (cA, co & oh only)
                                                                           exp. date                                 cid#
                                                                                                                                            Applies to in-stock items only. Call for shipping rates
state                              zip
                                                                                                                                            and availability. fedex cannot deliver to p.o. boxes                           Subtotal
                                                                            m m     y   y                                                   or p.o. zip codes.
gift message:                                                                                                                                                                                                              subtrAct: any gift certificates
                                                                                                                                                                                                                           or coupons

                                                                           signature of authorized buyer                                                                                                                   ToTal in u.s. dollars



                                                                           ------------------       thank you!    please make sure you've included your complete name, address, zip code, phone number and payment information.                                   ------------------