Print and send with your payment. We accept Checks, Money Orders, and Credit Cards
~Willowroot Wands ~
Order Form
Name: _________________________________________________________________
Address: _______________________________________________________________
City: _____________________________ State: ___________ ZIP: _______________
Country: _______________________
E-mail: ______________________________________________ Phone: ________________________
Payment: Check ___ USPS Postal Money Order: ___ Credit Card ____
___________________________________________________________________________
Credit Card # __________________________________________ Expiration Date: ___________
Name on CC: ____________________________ Billing Address:
___________________________________________________________________________
Item: ______________________________________________________________ Price: ______________
Item: ______________________________________________________________ Price: ______________
Item: ______________________________________________________________ Price: ______________
Item: ______________________________________________________________ Price: ______________
International Customers send $18.oo for Shipping Shipping: $7.50
Canadian Customers pay US Shipping Rate ____________________
TOTAL: $
___________________________________________________________________________________
Notes:
_________________________________________________________________________________________
Mail to:
Willowroot Wands
PO Box 3675 :
Fremont, CA 94539 :