Amazon EarthWorks Order Form
Instructions for
Ordering from Amazon EarthWorks
Ship To:
Name:
Address:
City:
Prov/State:
Postal Code/Zip:
Country:
Billing Address:
(if different)
Name:
Address:
City:
Prov/State:
Postal Code/Zip:
Country:
Quantity
Item #
Design Name
Color
Description
Unit Price
Subtotal
2
PB31
Star & Crescent
Blue
Pump Bottle
$25.00 Cdn
$50.00 Cdn
Please fill in your order as in the
above example
The prices listed on website are subject to change without notice
Do you need this order filled by a specific date?
If so, please let us know Month:
Day:
Payment Info:
Select Type of Card:
MC
VISA
Check Enclosed
This is NOT a secure order form.
In order to process this form online, you MUST let us know what type of card you will be using for this order. Then, DO NOT fill in the number or expiration date, we will call you for that information when we are giving you the shipping information. You can also call us at your earliest convenience to submit the numbers and to get final charges at 604.885.6447.
If you are faxing or using postal mail for this order, go ahead and fill it in before printing. Email us for our fax line.
Credit Card #:
Expiration:
Month
Year
Name on Card:
Your EMAIL:
Please make check or money order payable to
Amazon Earthworks
Sorry, no C.O.D.
Subtotal:
(PST 7%, B.C residents only)
Tax:
(GST 5%, Canadians only)
Tax:
Shipping Method:
UPS Ground or Canadian Post (whichever is lowest)
2nd Day Air
Next Day Air
International Air
Please select shipping method above.
BEFORE COMPLETING YOUR ORDER WE WILL CONTACT YOU via EMAIL or PHONE to give you the final amount due for shipping.
Phone Night:
Include Area Code
Phone Daytime:
Total: