Easy Order Form
 Order Online at www.goldstarherbs.com

Gold Star Herbs
 4066 Jefferson
P.O. Box 50
Clarklake, MI 49234
1-800-579-4074

www.goldstarherbs.com

Please print carefully and accurately and enter all information to ensure prompt and correct delivery. DOUBLE-CHECK YOUR ORDER BEFORE SENDING.

ORDERED BY:
NAME:____________________________
ADDRESS:_________________________
CITY, ST, ZIP_______________________
PHONE:___________________________
E-MAIL____________________________

SHIP TO:

NAME:___________________________
ADDRESS:________________________
CITY, ST, ZIP______________________

METHOD OF PAYMENT:
_____ Check
_____ Money Order
_____ Certified Check
_____ Credit Card

Credit Card Information:
____ VISA   ____ MasterCard   ____ Discover   ____ AMEX
Card #:________________________________________
Expiration Date:_________________________________
Verification # (last 3 digits on back of card)_______

Signature:______________________________________

QTY

ITEM NUMBER

ITEM DESCRIPTION

PRICE EACH

EXTENDED TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Merchandise Total

 

Sales Tax (MI residents add 6%)

 

Shipping and Handling (chart at left)

 

GRAND TOTAL OF ORDER

 

    Shipping Rates
(all Currency in US Dollars)

    USPS with Confirmation  $ 5.95