MAIL ORDER FORM

CREATION SOAP ORDER FORM -

Print and complete this form to order by fax or mail.

Mail Orders To: Creation Herbal Products 2760 River Road Frankfort MI 49635 or

Order by phone 1-231-352-9600

Bill To Information:________________________________

Full Name:__________________________________________

Company:____________________________________________

Address:____________________________________________

City:____________________State:__________Zip________

Country:________Telephone:__________________________ Visa or Mastercard#___________________________________ exp. date_________________

Work/Alt. Phone:_________________Fax:_______________

E-mail:_____________________________________________

Ship To Information:

Full Name:___________________________________________

Company:_____________________________________________

Address:_____________________________________________

City:______________________State:_______Zip:_________ Country:___________Telephone:________________________

Work/Alt. Phone:_____________________________________

Fax:______________________E-mail:____________________

Payment Information:

Card #______________________________________________

Circle 1:Visa Mastercard American Express Discover

Exp. Date_____________Signature_______________________

Name as Appears on Card:_______________________________

S i g n a t u r e :____________________________________

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Product Id#______Product__________________________ Size_____Price_______Qty____Total This Item_______

Sub - Totals__________________________

Totals________________________________

*Shipping & Handling for Ground Shipments Base Shipping is $6.95 per order plus .55 for each pound of products.

Total of Order MIchigan Residents Only: Add Sales Tax of 6%

Add Shiping & Handling Total (or call for shipping quote)

3-Day select, 2nd Day & Next Day Air shipping Call for Quote

Total Order A m o u n t_____________________

Creation SOAP - www.creationsoap.com