Ayurvedic Remedies Holistic Company: Order Form

Please enter all the products you want please.!

We ship out all products by Priority Mail. The shipping & handling cost is $7.00 domestic and international shipping is $10.95

Ayurvedic Remedies Holistic Company also has a 24 hour fax number for you to fax order form. The fax number is (352) 732-4799.




Order (Enter the name of the product with quantity and the product ID you want to order):

Product 1:

Product 2:

Product 3:

Product 4:

Product 5:

Product 6:

Product 7:

Name:
Company:
Shipping Address:
City:
State:      Zip:
Country:
Phone:   Fax: 

Email Address:

Payment Method:
Credit Card #:
Credit Card Security Code 3 Digits (Located On The Back Of The Card):
Expiration:     
Is the above address your billing address? If no fill out the following information below! Thanks!
Billing Name:
Billing Address:
City:
State:     Zip:
Country:
Shipping Method:
Comments:

 

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AYURVEDIC REMEDIES INC. IS A SECURE SITE OFFERING PRIVACY & PROTECTION FOR INTERNET TRANSACTIONS.

THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE FDA. THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE,TREAT, CURE, OR PREVENT ANY DISEASE.

COPYRIGHT © 1998-2002 AYURVEDIC REMEDIES INC. ALL RIGHTS RESERVED.
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