MOONSHINE NATURALS
Fax / Mail
ORDER FORM
Moonshine Natural Products
P.O. Box 713
Reedsport, OR 97467
E-mail: moonshine@presys.com
Phone/Fax (541) 271-1155
Method Of Payment:
Payment in advance via check or money order. To place your
order, please print this form and submit it to us via mail or by fax.

 
Name:
Address:
City: State: Zip:
E-mail: Phone: Fax:
 
PRODUCT CODE
SIZE (oz.)
Qty.
DESCRIPTION
PRICE
   Total   
           
           
           
           
           
           
           
           
  SUBTOTAL:

  
Shipping and Handling Chart
For orders of:
Up to $10........
$11 to $30.......
$31 to $50.......
 Add:
$4.00
$4.50
$5.00
 $51 to $70.......
$71 to $90.......
$91 to $150......
Over $150........ 		$5.50
$6.00
$6.50
$7.00
SHIPPING
& HANDLING:

  
Please add 5% extra shipping charge for Alaska, Hawaii and Canada. For C.O.D. orders there is an additional charge of $5.50.
 C.O.D. CHARGE
OR 5% EXTRA
SHIPPING
CHARGE

  
Checks or money orders should be made payable to: Moonshine Naturals.
 TOTAL:

  

All of the Moonshine Naturals Products are handmade and made to order, so please allow 2 weeks for delivery.