Wholesale Order Form

Mailing Address
rootsherbal.com
Attn: wholesale discounts
927 Holly Blossom Court
Great Falls, VA, 22066 USA


First Name:_______________________________________
Last Name(family or surname):_______________________________________
Business Name(if available):_______________________________________
Shipping Address:_______________________________________
 _______________________________________
 _______________________________________
Phone number:_______________________________________
Email:_______________________________________

Product Quantity Price (US $)
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Subtotal (before discount) __________
Subtotal after 50% discount (minimum $500) __________
  Shipping __________
  Total __________

Payment method: We accept Money Order, Cashier Check, Draft
Payments must be made to "Roots Herbal Industries and Exports" and must be in US dollars.

For more information please see http://www.rootsherbal.com/PageBusiness.html

www.rootsherbal.com