| DATE: |
CUSTOMER
REF: |
INVOICE: |
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you ordered from us before? Yes [ ] No [ ] |
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BY: (Block Capitals please) |
DELIVERED
TO: (if different) |
| NAME: |
NAME: |
| ADDRESS: |
ADDRESS: |
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CODE: |
ZIP
CODE: |
| TEL
NUMBER: |
TEL
NUMBER: |
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e-mail:.................................................................
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DATE REQUIRED BY:............................................ |
| QTY |
PRODUCT
DESCRIPTION |
SIZE |
PRICE
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TOTAL
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SUBTOTAL |
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POSTAGE
and PACKING |
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GRAND
TOTAL |
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METHOD OF PAYMENT
(please tick) CHEQUE [ ] CREDIT CARD [ ] MasterCard / Visa / Amex / ( )
Card Holder
Name and Initials (as on card) ______________________________________
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Signature : ___________________________
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Treasure
of Egypt, 1499A Memorial Drive - Stone Mountain, GA 30088 Tel: 404-933-2129
email: thenaturalhealthnews@hotmail.com
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