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Product Order Form
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To order our products, please submit the below order form to:
Essentials For The Special Woman
54 Hartford Turnpike
Vernon, CT 06066
Phone: 860.647.6996; Fax: 860.646.8900
Email: essentialfor@sbcglobal.net
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Name:
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Address:
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City/State/Zip:
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Phone:
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Fax:
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Email Address:
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Item #
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Quantity
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Item Description (Include Size/Color
Options)
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Item Price
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Total Price
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Subtotal
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Shipping
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CT
Residents
add 6% Tax
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Total
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Purchase Amount
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USPS Shipping Rate
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$0.01 - $9.99
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$5.95
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$10.00 - $19.99
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$7.95
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$20.00 - $39.99
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$8.95
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$40.00 - $59.99
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$9.95
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$60.00 - $79.99
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$10.95
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$80.00 - $99.99
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$11.95
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For all orders over $100
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Add an additional $1.00 per each
$20.00 worth of purchases
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Payment being made via: Check ______ Visa ______ MasterCard ______
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Credit Card #:
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Expiration Date:
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Signature:
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General Information
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Privacy Practice
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Contact Us
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