www.yourorganzabag.com DROP SHIPPING Date:
P.O. Box 661510, Arcadia, CA 91066-1510 P.O. #:
Sold to: Ship to:
Email: Email:
Phone: Phone:
Fax: Fax:
*********************************************** FAX THIS FORM TO: 1 - 626 - 226 - 4088 *************************************************
Qty Item # Description Color Unit Price Line Total
DROP SHIPPING DROP SHIPPING DROP SHIPPING DROP SHIPPING DROP
Subtotal $ -
Billing Information * required Sales Tax
1. First Name : 10% Discount when you order $200+
2. Last Name: Shipping and Handling Fee $7.50
3. Card Type: Total
4. Credit Card Number:
5. Expiration Date of Credit Card:
6. Billing Address: Authorized by Date