The Inner Light Shoppe - Email/Fax Order Form

THE INNER LIGHT SHOPPE
Your Internet Store of Unique Products for the Body, Mind & Spirit


	To Search Our Entire Website:

THE INNER LIGHT SHOPPE
MAIL ORDER FORM

Product Description	Item Code	Unit Price	Qty	Amount Before Shipping
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			Subtotal	$
			Michigan Residents Add 6% Sales Tax	$
			One-time Standard Handling Fee	$ 2.00
			Shipping Cost: Total from Below	$
			Total Amount Enclosed	$

We only ship to the United States and its Territories plus all Provinces of Canada. Print out then hand fill in or
type in your order information then Mail. Any questions call between 9:00 am & 5:00 pm (248) 852-0126

Today's Date: __________________________

BILL TO:
Name:_____________________________________________________________________________________
Address:__________________________________________________________________________________
City:_____________________________________________________________________________________
State: ________________________________________________Zip Code:__________________________
Day Telephone #:__________________________________Night Telephone #:__________________
Email Address:___________________________________________________________________________

Check here to SHIP to above address: ____

SHIP TO: (complete if different than above)
Name: ___________________________________________________________________________________
Address:_________________________________________________________________________________
City:_____________________________________________________________________________________
State: ________________________________________________Zip Code:________________________

ORDERING INSTRUCTIONS:
Print out Order Form! Fill in Credit Card Information or Make Check or Money Order payable to
The Inner Light Shoppe. Then either Mail this form to The Inner Light Shoppe (see additional
instructions below).

Paying By: (check one)
Money Order_____ Cashier Check_____ Personal Check_____ Credit/Debit Card_____

Paying by Credit/Debit Card:
Type of Credit/Debit Card:     Visa_____ MasterCard____ American Express___   Discover Card____
Name on Credit//Debit Card:_____________________________________________________________________________________
Credit/Debit Card Number:______________________________________________________________________________
Expiration Date: ______________________   Security Code (last 3-Digits on Back of Card): ______________
Amount Charging to Credit/Debit Card: $____________________________
Signature of Person on Card:___________________________________________________________________________

Ordering By Mail:
Complete form with Credit/Debit Card information or make a Cashier Check, Personal Check
or Money Order payable to The Inner Light Shoppe then send to:
The Inner Light Shoppe
P.O. Box 214988
Auburn Hills, MI 48326

SHIPPING INFORMATION:
Use Form Below to Calculate Shipping Costs:

PRODUCT DESCRIPTION	SHIPPING COST FOR ONE	QUANTITY OF PURCHASE	MULTIPLY COST TIMES QUANTITY FOR SUBTOTAL SHIPPING COST FOR THIS ITEM
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		GRAND TOTAL OF SHIPPING COST: ADD TO ABOVE ORDER FORM	$