Online Order Form
Name:

Mailing Address:

Shipping Address (if different from above):


Send as a gift
Include a card

Phone Number (home):

Phone Number (business):

E-Mail Address (eg: goodness@natural-goodness.com):



Long distance customers, please state courier preferance:

Method of Payment:
(check one)

Cheque
Credit Card

If Payment is being made by credit card, please indicate the following:
Mastercard
Visa

Name on Card:

Card Number:

Expiry Date:


If order is to be sent as a gift, please provide message for inside of card.


Local customers, if necessary please give basic directions to your residence or place of work and give a time preference (day/evening) which is more convenient for you to receive the delivery:


Upon receiving your mail or fax order, we will notify you within 24 hours of your order's total, your expected delivery date and any delivery charges (if they apply). Local deliveries will be made by our driver. If out-of-town and shipping is required, we will generally use Can Par unless the customer has specified otherwise.
Quantity
Item Description
cost
1