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:
Golden Eagles, LLC
40913 N 3rd Ave
Phoenix, AZ 85086
Fax orders to: (888) 766-4532

Stock Number

Description

Quantity

Unit Price

Total Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sub Total:
 
Shipping/Handling:
$12.00
Arizona Customers Add 6.3% Sales Tax:
California Customers Add 9% Sales Tax:
 
Total Due:
 

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

City, State, Zip
___________________________________________

Phone

Bill To: (If different than Ship To:)
___________________________________________
First Name
___________________________________________
Last Name
___________________________________________
Address
___________________________________________

City, State, Zip
___________________________________________

Phone

___________________________________________
Email(optional)

Payment Information: (Make Checks/Money Orders payable to Golden Eagles, LLC)

____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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