www.Salviamart.com Order Form

 SEND TO: 1365 Dove Meadow Rd

                      Solvang, CA 93463 

NAME: ________________________           

PHONE: _______________________

EMAIL: ________________________

ADDRESS: _____________________

  ______________________________

  ______________________________

PRODUCTS: _____________________   PRICE: ____________

                      _____________________                   ____________

                      _____________________                   ____________

                      _____________________                   ____________

SHIPPING    DOMESTIC (1st Class) $2.95  (Priority) $9.99  INTERNATIONAL $12.99

TOTAL: _______________________________________________

Round to the nearest dollar amout. Please do not send coins. Print all items legibly.