South African 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 012.361 0061
Click here to return to the home page, or here for our South African product catalogue, or use the "back" button of your browser to go back to the previous page.
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PLEASE NOTE – We charge R 30.00 extra for delivery anywhere in South Africa.
A minimum order of R 150.00 must be placed to qualify for the R 30.00 subsidized courier fee. If your order is less than R 150.00 - a "small order fee" of R 40.00 must be added to your total.
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FAX ORDER FORM | |
Surname | | |
Name |
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Physical address |
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| Postal code |
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South
Africa |
| Telephone number |
(Area + number) |
| e-mail address |
(used to confirm dispatch) |
| Items required |
Item name |
Quantity |
Price
(ZA
Rand) |
Total |
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Courier charges |
R 30.00 |
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TOTAL TO BE BILLED |
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| Credit card details |
| Credit card type |
(Specify Visa, MasterCard, Amex or Diners) |
| Card number |
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| Expiry date |
Month then year |
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| CCV number |
Visa and MasterCard cards > |
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Amex cards > |
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| Your signature |
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| Special instructions and notes |
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