PRINT AND MAIL TO THIS ADDRESS:

PURE LAND, 6260 E. RIVERSIDE BLVD., Suite 102, Loves Park, Illinois 61111 USA

WEBSITE http://www.ethnobotanicals.com/

For your convenience this is a form. You may type all your order information before you print. You may also cut and paste product names from our online catalog, or print form and write items in by hand.
Name: Date:
Address:
City: State: Zip:
Check box to agree to disclaimer: I have read and I agree to all terms in the DISCLAIMER, and I am 18 years of age or over, both certified by my signature below.
Signature:

Email:

Quantity (weight in gram/milligram liquid volume, or # of seeds)
Item Description

(Botanical Name of Specimen Material, Seeds, or Full Name of Research Material )

Total Cost

of this quantity of this item

  
SUBTOTAL:
  
LESS ANY CREDIT:
 
5% SALES TAX (ONLY Wisconsin Residents need to pay this):
 
SHIPPING ($4.95 for Priority Mail, or $20.00 for Express):
 
TOTAL(make payment out to 'Pure Land'):
IMPORTANT: If item(s) temporarily unavailable, do you prefer (check one box):
1. Substitution (list choices on back of this order form)
2. Back Order (up to 6 weeks maximum, after that point we would issue refund)
3. Refund if not in stock or due to arrive soon (company check made out to the customer's name) 4. Credit to be subtracted from your next order (we will send a credit note).

POSTAGE & PACKING COSTS: Priority/First Class Mail - Up to 900 grams (2 pounds): $4.95 ; Up to 1350 grams: $7.00 ; Up to 1800 grams: $8.00 ; Up to 2250 grams: $9.00 ; Up to 2700 grams: $11.00 ; Up to 3150 grams: $12.00 ; Add $1.00 MORE for each additional pound (450 grams) above 3150 grams. SHIPPING INFO for all U.S. clients: We ship by Priority Mail with the U.S. Postal Service. All orders are packed in Priority Mail boxes and the shipper's name in the return address will be 'PLE'. The USPS generally takes 2-4 working days to deliver Priority Mail. Express Mail service is available (overnight to most locations once your order is shipped) for an additional $15.00. Please indicate this preference above on the Shipping line.

Payment is accepted in three convenient ways:

(1) Order using Visa, Mastercard, Discover, or American Express credit or debit cards ( debit cards must have the Mastercard or Visa logo). Remember we need to ship to the SAME address as is on card.

(2) Mail us your payment in the form of a Money Order, Personal or Business Check or Cashier's Check (make out to "Pure Land"). Personal/business checks are accepted however we must wait for them to clear before we can ship your order, until you become an established customer. Money orders are therefore preferred for faster service.

**Credit Card Information Must Be Entered By Hand**
MASTER CARD VISA DISCOVER AMERICAN EXPRESS

Card number:

________ /________/ ________ /________ 

Exp. Date:________ /________ (Please note: your card will be charged immediately to reserve your order)

NAME AS PRINTED ON CARD:

(MUST be same as 'Ship to': name) ______________________________________________

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