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I need help.® Communication Bracelets – Order Form

Use this form only if you want to pay with a check or to be invoiced. Use PayPal, shopping cart buttons, on bracelet home page, to pay with a credit card.

Email or mail purchase orders from school districts/companies (please provide Tax ID No. and Certificate of Exemption (Form ST-3 when possible)) are accepted. Satina will invoice for payment.   Purchase Orders and/or order forms with checks and/or money orders written to Satina are accepted. 

Ship to:


Phone: _________________________________________
Email: ____________________________________
Where did you hear about the I need help bracelets? ______________________________________________
Bracelets will be used by/for:_____________________

Bill to:


Phone: _________________________________________
Email: __________________________________________
Exempt Sales:  Please provide MN Tax ID  number and Certificate of Exemption (Form ST-3): ____________________________
Check Number: ________________________

See Bracelet Catalog for Part Numbers and Price

Order Date:                                       Check Number:

Bracelet Name

Bracelet Catalog
Part Number


Youth Size Quantity

Adult Size Quantity

Total Bracelets  Ordered

Subtotal Price




Pre-Sub Total Price


Mail check and bracelet orders to:
I need help.® Communication Bracelets
c/o Sherri Goehring,

4664 130th Street West
Faribault, Minnesota 55021

US Shipping and Handling Fee
1 to 3 bracelets add $4.90
4 to 10 bracelets add $6.10
11 to 30 bracelets add $14.40
26 to 300 bracelets add $19.95
301 to 500 bracelets add $28.00

Note: Canada, Mexicao and all International orders see shipping rate listed below**


Sub-Total  Price


Note: MN Exempt Sales that provide Tax ID No. and Certificate of Exemption (Form ST-3) does not add tax.

Minnesota Only Tax (MN residents only add 7.375% tax to sub-total)

 (To calculate MN Tax: 7.375 x Sub-Total = TAX)




**Canada and Mexico shipping fees: 1 to 10: $15.00, 11 to 25 $34.00, 26 to 300 $55.00, 301 to 500 $75.00
All other International shipping fees: 1 to 25 $25.00, 26 to 300 $80.00, 301 to 500 $99.00

Satina website: www.ineedhelpcommunicationbracelets.com Telephone 952-270-3249, Email Ineedhelpcommbracelets@gmail.com