Mail or Fax Order Form

Mail or Fax in your order to Herbal Wear

Print out the following order form for your
Shoulder Wrap and Belted Lumbar Pack Promotion and either:

Fax it to (818) 609-7548 or Snail mail it to: Herbal Wear, 11423 Moorpark Street, Suite 100 Studio City, CA 91602

Name: _________________________

Email: _________________________

Company (optional): _________________________

Address: _________________________

City: _________________________ State: _________

Zip: _________

Phone: (___) ____ - ______

Imagine.. within a week, you could be feeling the benefits of your Hot / Cold Aromatherpay Packs - Enjoy!

( ) I am enclosing a check or money order for $46.90 (39.95 + $6.95 for shipping, plus applicable sales tax for California)
Please make checks or money orders payable to the Herbal Wear Center.

( ) I want to charge this purchase to my Credit Card

Credit Card (check one):

VISA

MasterCard

American Express

Card Number: _____________________________________

Expiration Date: ___________

Signature: _________________________

I authorize Herbal Wear to charge my credit card a total of $39.95 plus $6.95 for shipping and any applicable sales tax (California Residents Only)

If you have any questions, call our office between 8am and 5pm PST at (818) 609-7548