Manual Order Form

          
   
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Bethel Botanicals
659 Chestnut Street, Newton, MA 02468
Phone (617 964-1806) Fax (xxx) xxx-xxxx

Producing and distributing the highest quality natural and organic products

  
E-mail:   State or Province:  
Name:   Postal Zip Code:  
Address:   Country:  
    Telephone:  
May we contact you periodically via post or email to let you know about new products or special offers? Yes No
 
Payment Method:
  • MasterCard
  • Visa
  • Check
  • Money Order
 Card Number:  
Expiration Date:  
Signature  
  Note: Products must be shipped to credit card billing address on all credit card orders
Products
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Product ID
Description
Quantity
Price Each
Extended Price
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Product Total:
  
Shipping & Handling:
  

6% Sales Tax (Vermont residents only); 5% Sales Tax (Massachusetts residents only):

  
 
 
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