Fax an order for Colonial Ear Candles!
Please print this form, fill-in the required (*) information, and fax it to:
1-318-742-5253
(Package price includes Shipping, US, Canada, Mexico)
Credit card information destroyed after processing!
* Please check one package: (Package price includes Priority Mail shipping)
12 candles @ 24.95___ 24 candles @ $39.95___
48 candles @ $69.95 ___ 100 candles @ $107.00___
150 candles @ $150.00___
More! Enter amount @ $1 each (shipping free)_________
* Bill to: * Name (exactly as it appears on card)____________________________
* Address (on record with your bank)_______________________________________
________________________________________
Ship to: (If different from billing) Name__________________________________
Address________________________________
___________________________
* Type card: VISA ___ MasterCard ___ Discover ___American Express___
* Card number: ______________________________________________ * Exp. Date _________
Special Instructions, Comments: ______________________________________________________________________________________________________
______________________________________________________________________________________________________
Confirm my order by:
Fax (fax #) _____________________ Phone: _____________________ E-mail: ______________________