ORDER FORM
Mail Order Form to: ALTERNATIVE Health & Herbs REMEDIES 425 SE Jackson Street Albany OR 97321	1% Discount for FAX orders 1-541-791-8401 2% Discount for E-Mail orders. For information, contact healthinfo@healthherbs.com USA Voice Order Line: 1-800-345-4152 Outside USA Order Line: 1-541-791-8400

     Name: ____________________________________________________________________



  Address: ____________________________________________________________________



     City: ____________________________________  State: _____  Zip: ___________



Telephone: ____________________________________





PRODUCT #      PRODUCT NAME                      SIZE  QTY  UNIT PRICE  TOTAL       





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Thank you for your order!                                 SUBTOTAL     $____________



                                                 Shipping/Handling*      ____________



Shipping/Handling for USA only                                            TOTAL     $

For orders up to $ 65: $ 5.50                                           ============

           up to $100: $ 8.50

           up to $145: $12.50

           up to $200: $16.50

           over $200: no charge



PAYMENT: ___ Discover ___ Mastercard  ___Visa ___Check/Money Order



Credit Card #: _______-_______-_______-_______  Expiration Date ____/____

                                                            (month/year)																   



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Signature



*For orders outside the USA, we will contact you regarding the additional
 shipping charge.