Jackie McDaniel, D.C
PO Box 1654
Joshua, TX 76058

Quantity Herbal Lotion Formula
Cost/Each
Total
  Original Herbal Citrus Formula - 4 oz.
$44.00
$
  Original Herbal Citrus Formula - 2.5 oz.
$30.00
$
  Original Herbal Citrus Formula - .5 oz.
$11.00
$
  Extra Strength Floral Citrus Aromatherapy - 4 oz.
$55.00
$
  Extra Strength Floral Citrus Aromatherapy - 2.5 oz
$37.00
$
  Extra Strength Floral Citrus Aromatherapy - 1 oz.
$22.00
$
  Citrus Blend Expectant Mother's Formula - 2.5 oz.
$29.00
$
  Citrus Blend Expectant Mother's Formula - 1 oz.
$18.00
$
  Herbal Lotion Formula 5 - Skin Conditioner - 1 oz.
$20.00
$
  Herbal Lotion - Formula 5 - Skin Conditioner - 2.5 oz.
$35.00
$
Subtotal
$
FREE SHIPPING!
$ 0.00
Total Due
$

Date: ________________

Ship to: Name: _____________________________________________________

Shipping Address: _______________________________ Suite _______________

City________________________________ State _________ Zip _____________

Telephone number: (required to process order) ( ______ ) _____________________


Mail order with payment (credit card #, check or money order) to :
Dr. Jackie McDaniel
PO Box 1654
Joshua, TX 76058


Credit Card Authorization (Please print neatly & fax to 1-866-796-HERB

I authorize Dr. Jackie McDaniel  to charge my:

_____ MasterCard ______ Visa ______ Discover (Check One Only)

Account number __________________________________________________

Amount: $__________________ Credit Card Expiration _____ / _____ / ______

Signature: _______________________________________________________

Please print credit card billing name: ____________________________________

Billing Address: _________________________________________ Suite _____

City________________________________ State ______ Zip ______________

Thanks for your order!! We appreciate the opportunity to serve you.