![]() |
Mail-in Order Form |
Address:____________________________________________________________________________________
___________________________________________________________________________________________
City:_____________________________________________ State: _________________ Zip: __________________
Country: _______________________________________ Country Code: __________________________________
Daytime Phone Number:__________________________________________________________________________
E-mail Address: _______________________________________________________________________________
City:____________________________________________ State: _______________ Zip: __________________
Country: _________________________________________ Country Code: ______________________________
Expiration Date: __________________________ Security Code (3 Digits from Back of Card): __________________
Issuing Bank: _________________________________________________________________________________
Name on the Card: ____________________________________________________________________________
Signature: ____________________________________________________________________________________
| Quantity | Description | Cost |
|---|---|---|
| ___________________ | ___________________________________________ | ___________________ |
| ___________________ | ___________________________________________ | ___________________ |
| ___________________ | ___________________________________________ | ___________________ |
| ___________________ | ___________________________________________ | ___________________ |
| ___________________ | ___________________________________________ | ___________________ |
| ___________________ | ___________________________________________ | ___________________ |
| ___________________ | ___________________________________________ | ___________________ |
| ___________________ | ___________________________________________ | ___________________ |
| Product Total | ___________________ | |
| Sales Tax (in Kentucky Only) | ___________________ | |
| Shipping Charges | ___________________ | |
| Order Total | ___________________ |
|
Calculating Your Order Total
All payments must be made in U.S. Dollars.
Please allow two weeks (four weeks if paying by personal check) to receive your products (after we receive your order). International and Custom Blend Orders may take longer.If you have any questions, contact us at Order-Inquiry@cosmetics.com. |