å Date_____________ (for office use)

Return Form to:

The Herb Cottage
442 CR 233
Hallettsville, TX 77964-4808
Office Phone and Fax (979)562-2153
e-mail: cindy@theherbcottage.com


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.

ORDER FORM

NAME OF ITEM

QTY.

$ EACH

$ TOTAL

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$_________

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$_________

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$_________

$_________

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$_________

$_________

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$_________

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$_________

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$_________

$_________

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$_________

$_________



Shipping Charges

$2.00

Subtotal

$_________

 

Tax ( TX Residents Only) 8.25%

$_________

 

TOTAL

$_____________




METHOD OF PAYMENT: Check, money order: _____ Please make check out to The Herb Cottage