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Bill To:
*Name: ________________________________ *Address: _______________________________ *City: ______________________ State: ______ Zip: _________ *Phone: _____________ *e-mail: ______________________ *Required fields for order to be filled. |
Ship To, if different than Billing Address:
*Name: ________________________________ *Address: _______________________________ *City: ______________________ State: ______ Zip: ____________ *Phone: _____________ *e-mail: ______________________ *Required fields for order to be filled. |
VETIVER ORDER FORM
| QTY. | $ EACH | $ TOTAL | ||
| VETIVER SECTION | ___________ | $4.75 | $_________ | |
| Shipping Charges | ||||
| Up to 6 Sections: $5.25 | ||||
| 6 - 12 Sections: $12.50 | ||||
| More than 12 Sections: $18.00 | ||||
| Subtotal | $_________ | |||
| Tax ( TX Residents Only) 8.25% | $_________ | |||
| TOTAL | $_____________ |