Buy Raiza Crème dot com Printable Order Form
http://www.buyraizacreme.com

Print this form to order by fax or mail.
Complete your order and send along with your credit card information or check or money order to:

.
To Fax Order:
(541) 447-1179
To Mail Order:
Buy Raiza Crème dot com
3790 NE McKay Creek Rd
Prineville, OR  97754
.
We will also accept credit card orders over the phone:  (541) 447-3431

We can accept credit card and eCheck orders processed through PayPal as well...
(A Paypal account is not necessary to pay via credit card with Paypal. It is fast, free and secure.)

Please Contact us for Quantity Discounts or any Questions You May Have.

QTY ITEM DESCRIPTION PRICE TOTAL
. . $ $ 
. . $ $ 
. . $ $ 
. . $ $ 
. . $ $ 
. 
Shipping and Handling : 
 
 		 Shipping & Handling 4.00
TOTAL ORDER .
CREDIT CARD INFORMATION
Name on Card -
Billing address -
Card Number -
Exp.date                                                    Circle One:        VISA      M/C 
CUSTOMER INFORMATION
Customer Name
Address
City                                             State                            Zip Code
Home Phone #                          Work Phone #                 Email Address

Please include your e-mail address, so we can send you your tracking number.