Product Order Form
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
Name:
Address:
City/State/Zip:
Phone:
Fax:
Email Address:
Item #
Quantity
Item Description (Include Size/Color
Options)
Item Price
Total Price
         
         
         
         
         
         
         
         
         
         
Subtotal
 
Shipping
 
CT
Residents
add 6% Tax
 
Total
 
Purchase Amount
USPS Shipping Rate
$0.01 - $9.99
$5.95
$10.00 - $19.99
$7.95
$20.00 - $39.99
$8.95
$40.00 - $59.99
$9.95
$60.00 - $79.99
$10.95
$80.00 - $99.99
$11.95
For all orders over $100
Add an additional $1.00 per each
$20.00 worth of purchases
Payment being made via:    Check  ______    Visa  ______   MasterCard  ______
Credit Card #:
Expiration Date:
Signature:
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