New, Easier-to-Print Passiflora Order Form  (Updated May 2006)
(Old, Full-Sized Passiflora Order Form)
(Or Just Buy Online With PayPal)

Please visit us on the web:

www.passiflora.com
Contact Passiflora

Ship To:

(No PO Boxes, Please)

Make Checks or Money Orders to:

Name:

Address:

Passiflora

Address:

PO Box 3431

Hayward, CA 94540

(Please include product code and description)

USD

Silver Perfume Funnel (fills small perfume-jewelry bottles)

$ 20.00

Totals:

Sub-Total:

$

California Tax 8.75 % (x.0875):

$

Shipping (Insured with Confirmation) up to $ 13 = $ 5.75 / $ 14-$ 26 = $ 7 / each $ 10 over $ 26 add $ 1 : 

$

Please add $2 for residential delivery :  

(Updated January 2006)                                                                                                                              Total:

$

(All prices subject to change without notice.)

   Passiflora sends out a Seasonal Email Newsletter that includes coupons for a
   free sample-sized Passiflora product with your orders. 
   Just include your email address with this form. 

   Email:  ____________________________________________

                              ______ Yes!  I'd like to sign-up for Passiflora's Seasonal Newsletter.
                              I understand that my personal information will never be sold or
                              shared.  Passiflora respects my privacy.

Alphabetical Product Listing

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