Your
Name___________________________________________________________________________________
Your Street Address 
(NOT PO Box # if by Credit Card):_____________________________________________________
           
______________________________________________________________________________________________
City, State and
Zip_____________________________________________________________________________
Your Daytime Phone No._____________________________________  
Email Address: ______________________________________ ADD TO OUR EMAILING LIST?  
__Y __N   
  
    | 
       Item 
      #  | 
    
       Name of Item  | 
    
    
       Quantity  | 
    
       Price Ea.  | 
    
       Total Price  | 
  
  
    | 1. | 
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    | 2. | 
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    | 3. | 
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    | 4. | 
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    | 5. | 
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    | 6. | 
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    | 7. | 
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    | 9. | 
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    | 10. | 
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    | 11. | 
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    | 12. | 
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    14. | 
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    | 
    15. | 
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    | 
       
      SubTotal From
      Above 
       
              | 
    
    
         
      --- 
      >
        
              | 
    $
       
             | 
  
  
    | 
       Add $2.50
      Shipping & Handling
        
              | 
    
      
    --- >
        
             | 
    $ 2.50
     
             | 
  
  
    | 
     
    
    Ship To International? (Outside U.S.) ADD  | 
    
     ---
    >  | 
    
    $ 3.50 | 
  
  
    | 
       
      Total
            Charge
        
              | 
    
    
     --- >
       
             | 
    $
       
             | 
  
      
      
      
      
      
      MAIL CHECK or MONEY ORDER TO:
 
  
  
    
      | 
       
      Sand Mountain Herbs.com  
   c/o Larry Chandler 
      321 County Road 18 
      Fyffe, AL  35971    | 
    
  
  
 
* Every order over $10 receives Free Packet of 
Red's Cock's Comb By Checking Here _____  
Copyright Sand Mountain Herbs.com                
*Need A Website?    , Larry Chandler's son, who designed this site, for 
more information.