Fax or Mail-In Order Form
Remember, you can order ALL of our products on-line using our shopping cart: www.organicpharmacy.org
You can Call-In your order toll-free at: 800.819.6742, or Internationally: +1.828.398.0702
or, FAX your order - 24 hours per day, 7 days per week to: +1.828.225.8859
or, e-mail us at: customerservice@organicpharmacy.org
or, send via regular mail to us:
Organic Pharmacy, Inc., P.O. Box 2291, Asheville, NC, 28802, US
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Product # |
Product Name |
Quantity |
Price | Total Price price x quantity |
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Sales Tax (for North Carolina residents only) - 7% |
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Shipping: On most orders - unless stated differently on the product page: the cost is $5.40 up to $100, then shipping is free.. Please call, or e-mail us for rates on shipping outside the Continental U.S. and/or for express shipping methods and rates. |
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Total Amount of Order |
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Shipping Information:
Your Shipping Name: _________________________________________________________
Your Shipping Address: _______________________________________________________
Your Shipping City: ____________________________ State: ____ Zip: _______
Country: ______________
Daytime Phone: ( ) _______________________
E-mail Address: _______________________________________
Card Holder Name: __________________________________________________________
Card Holder Address: ________________________________________________________
Card Holder City: _____________________________ State: ____ Zip: _______
Country: _______________
Daytime Phone: ( ) _______________________
E-mail Address: _______________________________________
Payment type:
o Visa o MasterCard o American Express o Discover o Carte Blanche o Check/Money Order (payable to: Organic Pharmacy, Inc.)
Your card number (all digits please)
____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____
Your credit card will be charged only for merchandise shipped including shipping and handling fees.
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Expiration Date Month - Year
Print Name: ____________________________________________________
Signature: ______________________________________________________