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| Mail to: |
Emz Blendz Soap
Co.
93 Oak
Ashland, Oregon
97520 |
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| Bill To: |
| Name: |
| Company: |
| Address: |
| City: |
State: |
Zip: |
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| ShipTo: |
| Name: |
| Company: |
| Address: |
| City: |
State: |
Zip: |
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| To provide better
customer service please include the following
information. |
| Day phone: |
| Night phone: |
| Fax: |
| E-mail: |
| Do you wish to
receive an ocasional e-mail notice about special
sales or new products? [ ] Yes [ ] No |
|
| Shipping
(Only within the US) |
| Up to
$20.00 |
$5.00 |
| $20.01 to $40.00 |
$6.00 |
| $40.01 to $60.00 |
$7.00 |
| $60.01 to $80.00 |
$8.00 |
| $80.01 to $100.00 |
$9.00 |
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| Quantity |
Item |
Unit Price |
Total |
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| Subtotal |
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| Shipping cost (See chart above) |
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| Total |
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| Payment
Options |
| [ ] Personalized
check or money order payable to Emz Blendz
Soapmaking Company |
[ ] Visa [ ] Mastercard Card #:
__________________________________ Exp. Date
(mo/yr): _____/_____
('Bill to:' Name and address above must match
credit card name and address.) |
| Signature: |
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