Order Form*

* PLEASE DO NOT submit an order from this form, for the time being. You will receive an error, and waste your time typing. Unfortunately we must ask you to print and mail an order form. We hope to have the situation resolved within the next few days, thanks!

Please fill out the following form to request products from Planetary Herbal Products. If your order is received before 5pm PST, a reply will be sent the same day. For credit card orders, please provide your phone # and we will contact you to obtain your credit card number. Please follow the directions below.

Please be aware that this page is not secure and only submit your credit card information if you are aware of that fact. It is conceivable that your Credit Card information will not be safe until it is removed from our server daily at 5pm PST. Note that this information does NOT remain on the server for extended periods of time. Thank you.

You may also print, fill out and mail an order form:
HTML (Web) format | Text (Notepad) Format | Document (MS Word) Format

Note that starred (*) fields are optional.

Name

Street address

Address (cont.) *

City

State/Province

Zip/Postal code

Country

Home Phone

Work Phone *

E-mail

Choose a product to see its catalog # and price.

Energy Modifiers

Planetary Purifiers

Planetary Tonifiers

Formulas for Women

Liquid Extracts

Chinese Herbal Classics

East Indian Ayurvedic Formulas

Teas and Beverages

Books, Tapes, and Other Specialties

Qty. Cat. #
Product Name/Description
Unit Price Total

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

Subtotal: $

Michael Tierra's East West Herb Course Student? If so, take off 15%: $

California Residents add 8.25% Sales Tax: $

6% Shipping, $4.00 Minimum: $

Canada & Overseas orders add $4.00 $

Final Total: $

BILLING

Credit card

Cardholder name

Card number

Expiration date

SHIPPING (if different from above)*

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Name
Street address
Address (cont.)	*
City
State/Province
Zip/Postal code
Country
Home Phone
Work Phone	*
E-mail

Energy Modifiers
Planetary Purifiers
Planetary Tonifiers
Formulas for Women
Liquid Extracts
Chinese Herbal Classics
East Indian Ayurvedic Formulas
Teas and Beverages
Books, Tapes, and Other Specialties

Qty.	Cat. #	Product Name/Description	Unit Price	Total
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
			$	$
Subtotal:				$
Michael Tierra's East West Herb Course Student? If so, take off 15%:				$
California Residents add 8.25% Sales Tax:				$
6% Shipping, $4.00 Minimum:				$
Canada & Overseas orders add $4.00				$
Final Total:				$

	BILLING
Credit card
Cardholder name
Card number
Expiration date

	SHIPPING (if different from above)*
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Order Form*

Š1999 Planetary Herbal Products. All rights reserved. Last Update: February 23, 1999 Global@PlanetaryHerbs.com

Š1999 Planetary Herbal Products. All rights reserved.
Last Update: February 23, 1999
Global@PlanetaryHerbs.com