Naturally Herbs Order Form

Naturally Herbs
Mail/Fax Order Form

If you do not wish to place your order online, you can print this form (using the print button on your browser), complete and send to:

Naturally Herbs
19841 N 14th St
Phoenix, AZ 85024
Fax orders to: (888) 766-4532

Stock Number	Description	Quantity	Unit Price	Total Price









Sub Total:
If sub total is less than $100, add $5.00 Shipping/Handling: If sub total is greater than $100, shipping is FREE:
Arizona Customers Add 8.1% Sales Tax: California Customers Add 8.5% Sales Tax:
Total Due:

Ship To: (If a PO Box is entered, shipping times may be delayed. We can only ship to US Addresses).
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First Name
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Last Name
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Address
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City, State, Zip
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Phone

Bill To: (If different than Ship To:)
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First Name
___________________________________________
Last Name
___________________________________________
Address
___________________________________________
City, State, Zip
___________________________________________
Phone
___________________________________________
Email(optional)

Payment Information: (Make Checks/Money Orders payable to Naturally Home)

____Check/Money Order Enclosed for $_______

Credit Card Information: ___Visa ___MC ___Discover
Credit Card Number:___________________________ Exp. Date: ___/___
Security Code (on back of card): ______
Signature:_________________________________________

Special Instructions (optional): _________________________________________________
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