Aromatherapy by TERE Order Form

Please supply ALL information and either
Mail to:Aromatherapy by TERE
P.O. 14891
Columbus, Ohio 43214		or Fax to: 614-760-8716

Name: 
Address Line 1: 
Address Line 2: 
City: 
State: 
Zip: 
Telephone: 
E-Mail: 

QtyItemPrice EachTotal
    
    
    
    
    
    
    
    
Payment Must be Made with Order
Please Make Checks Payable to: Aromatherapy by TERE
Sub-total: 
Shipping: 
TOTAL: 

If paying by Credit Card, please supply the following information:

Card Type: oVisa       oMastercard
Card Number: 
Expiration Date: 
Name as it appears on card: 
Signature: