Jai’s
Custom Made Soaps Mail Order Form
Send To:
Jai’s Custom Made Soaps, P.O. Box
930145, Norcross, GA 30003
Please
Print and Fill in Form Completely.
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Name:
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Co. Name:
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Payment Type
(Circle One):
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E-Mail:
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Visa, M/C, AMEX, Discover, Personal/Business/Cert. Check, M.O.
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Phone
#:
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Fax #:
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Card Expiration Date:
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How did you find us?
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Customer
#
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Credit Card #
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Address:
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City, State, Zip:
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Business Type:
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Ship To:
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Company Name:
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Contact Name:
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Purchase Order#:
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Complete Address:
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Special Delivery Instructions:
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Item
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Size
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Quantity Each
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Description
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Price Each
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Extended
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Subtotal:
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(GA. Res. Only Add (5.0 %):
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S/H:
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Order Total:
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Authorized Signature (MUST SIGN):
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Call in your Orders 770-374-8389
Click here to E-Mail to Us
Your comments, questions, or concerns
