Discovery Boxes Request Form



Please check the country(s) for which you would like to receive a Discovery Box and an alternate choice if ordering only one. If ordering more than one box, please number them in the order in which you wish to receive them and write in the preferred dates.

If there is a scheduling conflict, you will be contacted to schedule a new date.

Orders are available for shipping within the United States and Canada only.

Please complete the following information: 
          Name: 
       Address: 
          City: 
State/Province: 
   Postal Code: 
 Daytime Phone: 
         Email: 


Country Order Date Needed
Botswana   
Cameroon   
Ecuador    
Guatemala  
Liberia    
Namibia    
PNG        
(Papua New Guinea)
Special Instructions:

By checking this box, I am confirming this request.

If you are satisfied with everything you entered, click the "Send" button below.

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