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Herbtime
"Around the Clock Wellness"
Karyl Sellinger
138 Palm Trail
East Palatka, FL 32131
Customer Information
Billing Address:
Customer Name ________________________________ Date ___________________
Street _____________________________________ Phone # _____________________
City ______________________________ State ________________ Zip ____________
Email Address:________________________________________
Shipping Address:
Street _____________________________________
City ______________________ State ________________ Zip _____________
Credit Information
Check # ________________ Amount $ _________________
Money Order # ________________ Amount $ _________________
Please ship the following products to the above address
Make Checks Payable to: Karyl Sellinger- Herbtime
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Florida residents add 6% Tax
Shipping Costs: see chart below
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Subtotal
+Tax
+ Shipping
Total Cost |
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