| Name: |
___________________________ |
| Shipping Address: |
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| Address: |
___________________________ |
| City, State, ZIP |
___________________________ |
| Phone Number: |
___________________________ |
| E-mail Address: |
___________________________ |
Billing Address: (If different from shipping address) |
| Name: |
___________________________ |
| Address: |
___________________________ |
| City, State, ZIP |
___________________________ |
| Stock Number |
Description |
Quantity |
Unit Price |
Total Price |
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| Sub Total: |
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| ****Shipping/Handling: |
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| *** Retail Sales Tax: |
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| Total Price: |
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Payment Information**:
___ Credit Card ___ Personal Check ___ Money Order
Credit Card Information: ___Visa ___MC ___AMEX ___Discover
Credit Card Number:___________________________________ Exp. Date: _________ CVV _______
NOTES:
** You can choose to call us and give credit card information OR ask us to call you for that info. CVV is the 3 digit code listed on the back of your card.
***Tax: If the shipping address is in Virginia add 5%. If the product is on Product Page1, and the delivery address is in California, add 8%. In some cases, you will have overpaid and will receive a credit after we review your order.
****Shipping: Choose one of the following options:
- Add 10% for shipping. If this is more than is required, we will credit your card. If this is less than required, we will contact you before filling the order and give you the chance to either pay the extra shipping cost or cancel the order. Orders from Product Page1 probably will need more for shipping.
- Call us to calculate shipping for you before you submit the form. (We highly recommend this - if you have not paid enough, your order will be held up until the correct amount is received).
- Leave this field blank. After we receive your order, we will calculate shipping and contact you to either pay the shipping cost or cancel the order.
You can use your mouse to highlight this form and then copy and paste it into your email,
or into a document editor, and then complete it for submission.
Please email this form to:
email
OR
Please mail this form to:
Healing Rainbows
Fax orders to: 757-689-0224
Please make any checks payable to Rainbows Ltd
If you have questions, call us Toll Free 866-747-5751 or 757-468-0576
2904 Bald Eagle Bend, Virginia Beach, VA 23453 |
