Fax order form

To order any of our herbal products by fax, please print out this form, complete in black ink, sign and fax to our offices.

Our fax number is +27.12.361 0061

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FAX ORDER FORM
Surname 
Name  
Postal address  
   
   
   
Zip code  
Country  
Telephone number (Country code + area + number)
e-mail address (used to confirm dispatch)
Items required Item name Quantity Price
(US Dollars)		 Total
         
         
         
         
         
    TOTAL TO BE BILLED  
Credit card details 
Credit card type (Specify Visa, MasterCard, Amex or Diners)
Card number                                
Expiry date Month then year    
CCV number Visa and MasterCard cards >          Amex cards >            
Your signature  
   
Special instructions and notes  
   
   


Information contained on this website is for general information purposes only and must not be used to treat or diagnose
medical conditions, and all health problems must be referred to a health care professional. Statements made regarding the products, ingredients and general information have not been evaluated by the FDA, or any other health authority, and should not be seen as health claims. 

All ingredients used in our products are safe and are in no way banned, controlled or restricted and all products are manufactured
following strict GMP and ISO standards.

Our site was last updated on 13 June 2010 
© Sallamander Concepts 1998 - 2010