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Surya Incense Company RETAIL
. You can print this out and mail: 724 Peaceful Valley, Lyons, CO, 80540, U.S.A fax:303-747-2363 call:(toll free)1-888-540-2500 e-mail: mailto:sita@suryatrading.com |
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| Name: Address: City: State: Zip Code: Date: |
Phone: FAX: Email: Contact: | |||
| Item No. | Description | Rate | Qty. | Extn. Price |
|---|---|---|---|---|
| 10811 | Value Pack | $45/ea | _ | $ |
| 10812 | Variety Pack | $24/ea | _ | $ |
| Assortment of your choice | $24/doz | _ | $ | |
| 10815 | Amber | $2/ea | _ | $ |
| 10820 | Euphoria | $2/ea | _ | $ |
| 10825 | Forest Champa | $2/ea | _ | $ |
| 10830 | Jasmine | $2/ea | _ | $ |
| 10835 | Maharaja | $2/ea | _ | $ |
| 10840 | Nag Champa | $2/ea | _ | $ |
| 10880 | Rose | $2/ea | $ | |
| 10850 | Saffron Sandal | $2/ea | _ | $ |
| 10855 | Sampler Darbari | $2/ea | _ | $ |
| 10860 | Sampler Masala | $2/ea | _ | $ |
| 10865 | Royal Champa | $2/ea | _ | $ |
| 10870 | Sandalwood Supreme | $2/ea | _ | $ |
| 10890 | Mysore Sandal Cones | $2/ea | _ | $ |
| 10081 | Brass Incense Burner | $2/ea | _ | $ |
| Sub Total | _ | $ | ||
| Free Shipping within the U.S.A. | COD / S&H | $ | ||
 30
Day net |
Total | $ | ||
|
Payment enclosed COD
VISA
MASTER
DISCOVER | ||||
| Card Number Expiry date: __ / __ | ||||
| Authorized Signature: | ||||