Order Form (print and fill out) Name: Address: City: Province/State: Country: Postal/Zip Code: Phone: ( ) Fax: ( ) Email: Product Quantity Price ____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ _____________________________ ______________________ ____________________ Total ____________________ Please: All orders must be prepaid by credit card (VISA, Mastercard or American Express) cheque or money order in Canadian dollars. There are no taxes. Make personal cheques to Monteagle Herbs. You may call, write, fax or email your order. We can ship by parcel post, express post or courier. Please indicate preferred method of shipment and we will calculate and inform you of the cost and time of delivery. Minimum order $25.00 Shipping and handling extra. ----------------------------------------------------------------------------------------- Monteagle Herbs sales office 3416 Mountain View Road R.R.#4 Killaloe, ON. K0J 2A0 Email: monteagle@webhart.net Phone (toll free): 1-877-677-6055 Fax: 613-757-1291