Purchase Form

Purchasing Order Form

Please allow six to eight weeks for delivery. Special orders may take longer in which you will be informed via email or postal mail of the delay. Checks or money orders only are accepted unless paying via PayPal. When paying by check, the order will be sent once the check has cleared. After completing this form, your order will be verified via email at which time you will receive the total dollar amount of your order and the address in which to send your payment. If you have not received an email within five days, please email us.

Please check each item you would like to purchase. If the item requires additional instructions, please provide them in the boxes provided. Also, please read the Shipping and Handling Page.

Quantity:

Bottle 1:

Bottle 2:

Bottle 3:

Bottle 4:

Bottle 5:

Bottle 6:

Quantity:

Canister 1::

Canister 2::

Canister 3::

Canister 4::

Canister 5::

Canister 6::

Design::

Cover Color::

Design Color::

Design::

Holder Color::

Design Color::

Design::

Quantity:

Design::

Last updated: 4/6/2006

Moon Phase::

Hair Color:

Skin Color:

Name:

Street Address:

City:

State:

Zip Code:

Email Address: