Jai’s
Custom Made Soaps Mail Order Form
Send To:
Jai’s Custom Made Soaps,
Please
Print and Fill in Form Completely.
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Name: |
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Payment Type (Circle One): |
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E-Mail: |
Visa, M/C, AMEX, Discover, Personal/Business/Cert. Check, M.O. |
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Phone #: |
Fax #: |
Card Expiration Date: |
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How did you find us? |
Customer # |
Credit Card # |
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Address: |
City, State, Zip: |
Business Type: |
Ship To:
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Company Name: |
Contact Name: |
Purchase Order#: |
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Complete Address: |
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Special Delivery Instructions: |
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Size |
Quantity Each |
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Description |
Price Each |
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Subtotal: |
(GA. Res. Only Add (5.0 %): |
S/H: |
Order Total: |
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Authorized Signature (MUST SIGN): |
Call in your Orders 770-374-8389
Click here to E-Mail to Us
Your comments, questions, or concerns