Product List

Flora Medica - Order Form

Integrative Aromatherapy™ 100% Pure, Natural and Organic Essential Oils
Print this form out along with the Product List and fax or mail it in. INFO BELOW

CLIENT INFO : FILL IN
Payment Options - Personal Check or Money Order or Credit Card
Credit Card Charges (VISA/MasterCard)

Name:__________________________________________________________________

Address:________________________________________________________________

Phone:_________________________________________________________________

Email:__________________________________________________________________

Name on Credit Card:_____________________________________________________

Credit Card #:____________________________________________________________

Exp. Date:________________ Signature:______________________________________

Total Price from Product List: (include product list with selections and quantities marked)

$________

(please contact us for special shipping arrangements)

UPS Shipping with Insurance Coverage (street address required)

Rates below apply to Continental US only.
$7.50 ($1-75); $10. ($76-150); $15. ($151-300); $20. ($301 and up)

Please Make Checks and Money orders out to Flora Medica.

P.O. Box 130166, The Woodlands, TX 77393 • Fax: 1-877-363-3422

Thank You for your Order!