Seeds for Change Wellness Product Mail Order
                       105 Oak Drive
               Sellersville,  PA  18960
Product Name/ Description
Catalog Item #
Unit Price
Qty
 Total
ex: Spurling Ring 1/2 Sacred Cubit
1_2SC
$20.00
2
$40.00
         
         
         
         
         
         
         
         
         
         
         
         
    SUBTOTAL:
   
    INSURANCE:
   
PA residents add 6% sales tax
  PA Sales Tax
6 %
 
        TOTAL :
   
CUSTOMER INFORMATION:   Please Type or Print Clearly

Name:_________________________________________________________
Street Address: ________________________________________________
                          ________________________________________________
City/Town:          ________________________________________________
State:                  _________________ Zip Code: ______________________

Email Address: _________________________________________________
Telephone Number: ___________________

Payment Accepted:  Check or USPS money order
Insurance Must Be Added to the Bill for any orders totaling $100.00 this is to protect
against lose or damage. The insurance rates used are standard from the USPS. Please use
the rates listed below:

ORDER             INSURANCE          ORDER         INSURANCE       
$100 - $199             $2.60            $400 - $499      $ 6.50
$200 - $299             $4.60            $500 - $599      $ 7.45
$300 - $399             $5.55            $ 600 +             $7.45 plus $0.95 per $100