Order Form for Natural Medicinal Substances

Transcription

1 Order Form for Natural Medicinal Substances Date: Name/Company: Contact: Ship To Address: Ship To City, ST, ZIP: Tel: Fax: Payment Method (Circle One): Cash, Check, Credit Card, or PayPal Y / N Is Shipping Address Same As Billing Address?: If No, Please Enter Bill To Address: Bill To City, ST, ZIP: Iceland Spring Water Product Description List Price per Case Case of 24, 0.5 Liter bottle ($0.89 per bottle) $ Case of 12, 1.0 Liter bottle ($1.69 per bottle) $ Case of 12, 1.5 Liter bottles ($1.99 per bottle) $ Page 1 of 6 QTY Total Price

2 Dr. Young phlavor Liquid Sea Salt (8 oz. spray bottle) $ Dr. Young phour Carbonate Salts (454g powder) $ Celtic Sea Salt (Fine Ground) - 1/2 lb. Resealable Bag $ 6.99 Celtic Sea Salt (Fine Ground) - 1 lb. Resealable Bag $ Celtic Sea Salt (Fine Ground) - 8 oz. Shaker $ 9.99 Celtic Sea Salt (Flower of the Ocean) - 1/2 lb. Resealable Bag $ Celtic Sea Salt (Flower of the Ocean) - 1 lb. Resealable Bag $ Celtic Sea Salt (Flower of the Ocean) - 8 oz. Shaker $ Celtic Sea Salt (Light Grey Celtic) - 1/2 lb. Resealable Bag $ 2.99 Celtic Sea Salt (Light Grey Celtic) - 1 lb. Resealable Bag $ 5.49 Celtic Sea Salt (Light Grey Celtic) - 8 oz. Shaker $ 5.99 Celtic Sea Salt (Makai Pure) oz. Grinder $ 9.99 Celtic Sea Salt (Makai Pure) - 1/2 lb. Resealable Bag $ Celtic Sea Salt (Makai Pure) - 1 lb. Resealable Bag $ Celtic Sea Salt (Makai Pure) - 5 lb. Resealable Bag $ Celtic Sea Salt (Makai Pure) - 11 lb. Resealable Bag $ Celtic Sea Salt (Bath Salt) - 1 lb. Bag $ 5.49 Celtic Sea Salt (Bath Salt) - 5 lb. Bag $ Solay Himalayan Crystal Sea Salt (Coarse) - 8 oz. $ 8.49 Solay Himalayan Crystal Sea Salt (Coarse) - 20 oz. $ Solay Himalayan Crystal Sea Salt (Coarse) - 5 lbs. $ Solay Himalayan Crystal Sea Salt (Fine) - 8 oz. Cotton Bag $ 8.49 Page 2 of 6

3 Solay Himalayan Crystal Sea Salt (Fine) - 20 oz. Cotton Bag $ Solay Himalayan Crystal Sea Salt (Fine) - 5 lb. Cotton Bag $ Salt Mill (7" Tall Round) with Ceramic Grinder containing 8 oz. of Himalayan COARSE Sea Salt $ Solay Himalayan Salt Stones Starter Jar (2-month supply) $ Himalayan Crystal Sea Salt COOKING TILE - (4" x 6" x 1") - Pack of 2 $ Himalayan Crystal Sea Salt COOKING TILE - (4" x 6" x 2") - Pack of 2 $ Himalayan Crystal Sea Salt COOKING/SAUNA/BED TILE - (4" x 6" x 8") - Pack of 2 $ Himalayan Crystal Sea Salt ROUND COOKING PLATE - (8" Diameter) $ Himalayan Crystal Sea Salt (Bath Salt) - 1 lb. Cotton Bag $ 8.49 Himalayan Crystal Sea Salt (Bath Salt) - 5 lb. Cotton Bag $ Himalayan Crystal Sea Salt (Bath Salt) - 10 lb. Cotton Bag $ Himalayan Crystal Sea Salt Lamp - 7" (Small, 5-7 lbs.) $ Himalayan Crystal WHITE Sea Salt Lamp - 7" (Small, 5-7 lbs.) $ Himalayan Crystal Sea Salt Lamp - 10" (Medium, 9-13 lbs.) $ Himalayan Crystal Sea Salt Lamp - 12" (Large, lbs.) $ Himalayan Crystal Sea Salt Lamp - 17" (X-Large, lbs.) $ Himalayan Crystal Sea Salt Lamp for Computer - 4" (USB powered) $ Himalayan Crystal Sea Salt PLANET Lamp - 6" Globe $ Himalayan Crystal Sea Salt PYRAMID Lamp - 5" x 5" Base $ Rare Persian White Salt Lamp - up to 6", 2-4 lbs. $ Rare Persian White Salt Lamp - up to 8", 4-6 lbs. $ Rare Persian White & Purple/Lavender Salt Lamp - up to 6", 2-4 lbs. $ Page 3 of 6

4 Rare Persian White & Purple/Lavender Salt Lamp - up to 8", 4-6 lbs. $ Salt Lamp Light Bulb Replacement (15 watts, 110V) - Pack of 6 $ 5.79 Salt Lamp Electrical Dimmer Light Cord $ Solay Himalayan Salt Inhaler Pipe with Himalyan Salt and Free Himalayan Salt Refill $ Solay Ceramic Neti Pot with 1/2 lb. of Himalayan Salt $ Solay Salt Therapy Combo Kit (Inhaler Pipe and Neti/Nasal Pot) $ Solay Large Eye and Ear Salt Pillows (8" x 5") $ Solay Large Back and Stomach Salt Pillows (16" x 8") $ Solay Body Relief Pillows (18" x 5") $ Solay Natural Pain Relief Pillow Gift Set (1 x Eye/Ear Pillow, 1 x Back/Stomach Pillow, 1 x Body Relief Pillow) $ Solay Himalayan Salt Foot Bed (includes 10 lbs. of coarse Himalayan salt and silk drawstring bag) $ Himalayan Salt Lick lbs. (Mini) $ Himalayan Salt Lick lbs. (Small) $ Himalayan Salt Lick lbs. (Medium) $ Himalayan Salt Lick - 11 lbs. (Large) $ Flor Blanca Sea Salt (for food, cooking, and bathing) 8 oz. $7.95 Flor Blanca Sea Salt (for food, cooking, and bathing) 16 oz. $11.95 Flor Blanca Sea Salt (for food, cooking, and bathing) 32 oz. $19.95 Flor Blanca Sea Salt (for food, cooking, and bathing) 64 oz. (4 lb.) Container $39.95 Flor Blanca Sea Salt (for food, cooking, and bathing) 128 oz. (8 lb.) Container $79.95 Mayan Sun Sea Salt (for food, cooking, and bathing) 8 oz. $6.95 Mayan Sun Sea Salt (for food, cooking, and bathing) 16 oz. $9.95 Mayan Sun Sea Salt (for food, cooking, and bathing) 32 oz. $16.95 Mayan Sun Sea Salt (for food, cooking, and bathing) 64 oz. (4 lb.) Container $34.95 Mayan Sun Sea Salt (for food, cooking, and bathing) 128 oz. (8 lb.) Container $74.95 Page 4 of 6

5 Dead Sea Salt (Bath Salt) 8 oz. Container $6.95 Dead Sea Salt (Bath Salt) 16 oz. Container $9.95 Dead Sea Salt (Bath Salt) 32 oz. Container $14.95 Dead Sea Salt (Bath Salt) 64 oz. (4 lb.) Container $27.95 Dead Sea Salt (Bath Salt) 128 oz. (8 lb.) Container $49.95 Page 5 of 6

6 Zeolite Zeolite Pure grams of Maximum Micronized Zeolite $ Zeolite-AV - 90 Capsules totaling 81 grams of Zeolite and 1.8 grams of Humic Acid $ Destroxin - 90 Capsules totaling 72 g of Zeolite, 4.5 mg of B-12, and 6.48 mg of Calcium $ Esidifan - 90 Capsules totaling 72 g of Zeolite, 4.5 mg of B-12, and 7.2 mg of Calcium $ ZETOX - 6 g of Maximum Micronized Zeolite, 54 mg of B-12, and 12,000 iu of D3 $ Dead Sea Mud/Clay Dead Sea "Raw" Therapeutic Mud - 8 oz. Container $9.95 Dead Sea "Raw" Therapeutic Mud - 16 oz. (1 lb.) Container $16.95 Dead Sea "Raw" Therapeutic Mud - 32 lb. (2 lb.) Container $29.95 Dead Sea "Raw" Therapeutic Mud - 64 oz. (4 lb.) Container $49.95 Dead Sea "Raw" Therapeutic Mud oz. (8 lb.) Container $79.95 Subtotal = **Please fax Order Form back to Creation of the Sea at (908) or Order Form to info@creationofthesea.com for processing.** **7% NJ sales tax rate (for Bath Salt and Dead Sea Mud ONLY) and shipping & handling (if applicable) to be added at time of processing.** Page 6 of 6