Purchase Order

Purchase orders must be submitted by mail with full payment including State sales tax for Virginia residents.     
Sorry, but no email orders can be accepted at this time. 
Payment must be in the form of personal check, business check, bank check or money order     
Please fill out the following form, PRINT, SIGN and MAIL along with payment to:  

Earth Connection
P.O. Box 32
Somerville VA 22739
Please identify yourself: Please provide the following contact information:
Name
Age
Sex Male Female
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail
How did you hear about us?
Would you like to be on our email list?  
NO    YES  		 
Would you like to be on our mailing list?  
NO    YES  		 
Please select the item(s) for which you are purchasing:    

Quantity

Quantity

Quantity

Quantity

  Quantity

Subtotal of your order
Are you a Virginia State Resident? If yes, then please add 5% tax
NO    YES 

Please include $5 for Shipping

Please total your order here

WAIVER
In all products and information provided by Earth Connection - it’s assistant instructors, helpers, and Tim MacWelch, individually - reasonable care is taken to provide safe and helpful products and information. The purchaser states that he or she is fully aware that survival, primitive technology, wilderness skills and associated items may be dangerous. The purchaser by signing their name below hereby agrees to accept full responsibility for themselves and assume all risks, including those caused by acts of God, injury, death and/or loss to his or her person and/or property relating to the products and/or information provided by Earth Connection and Tim MacWelch, individually. The purchaser hereby waives all present and future rights to make any claims resulting in any way from using products and/or information by Earth Connection, its assistant instructors, helpers, and Tim MacWelch, individually.  
Signature of purchaser:                Date: 
(DO NOT TYPE - MUST BE WRITTEN SIGNATURE)
                                                                        

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