Essensuals Canada Canadian Order Form 
 "Open Your Mind... Soothe Your Body... Enhance Your Spirit"

Please provide the following order information:

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Please provide the following ordering information:
  Prices are in Canadian Dollars.

QTY	Pure 100% Essential Oils

QTY	Diffusers  -  Prices are in Canadian Dollars

S&H $ 1.00-$60.00 = $ 9.90
S&H $ 61.00-$ 100.00= $ 9.60
S&H $ 101.00 - $ 150.00= $12.50
S&H $ 151.00 - $ 300.00= $18.50
S&H over $300.00 - please e-mail us, Thank You.
We do this to keep your shipping cost lower.

	BILLING
Credit Card	VISA Cheque/Money Order
Cardholder Name
Card Number
Expiration Date

	SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

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