~MAIL IN ORDER FORM~
FLOWER PATCH SCENTS13901 Gifford Road, Oberlin, OH 44074
1-877-244-8408 ~
PLEASE PRINT FORM and
completely fill out
the information below~
Billing Address & Payment Information.
If paying by credit card, the address listed must match the address on
your credit card statement
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NAME: |
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ADDRESS: |
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ADDRESS: |
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STATE & ZIP: |
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PHONE #: |
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E-Mail: |
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PAYMENT TYPE: |
Visa/ MC /Discover/ American Express/ Money Order |
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Credit Card # : |
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Exp Date: |
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CVV2# (3 digit # on back): |
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Signature: |
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QUANTITY |
ITEM DESCRPTION |
PRICE |
TOTAL |
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Subtotal |
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OHIO Residents add 7% Sales Tax |
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Shipping |
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$6.99 |
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TOTAL |
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