Print Form and Mail or Fax to:
COOKS & JOHNSON NATUROPATHIC INC.
1506 Albany Avenue, Brooklyn, NY 11210-2019
Fax: 718-421-5227

Methods of Payment
(Please Check One): Visa ____ / MasterCard ____ / American Express ____ / Check or Money Order ____

Card Holders Name_______________________________________

YOUR CARD NUMBER (all digits please) ________ - ________ - ________ - ________
(Your credit card will be charged only for merchandise shipped)

Card Valid Through: Month _________ Year ________     

Signature______________________________

Name___________________________________________
Address_________________________________________ 
City______________________ State_____ Zip _________  
Daytime Phone (______)_____________
Item No. Quantity Brand and Product Size Price Total Price
Price X Quantity
______ _____ ___________________________________ _______ ________ __________
______ _____ ___________________________________ _______ ________ __________
______ _____ ___________________________________ _______ ________ __________
______ _____ ___________________________________ _______ ________ __________
______ _____ ___________________________________ _______ ________ __________
______ _____ ___________________________________ _______ ________ __________
______ _____ ___________________________________ _______ ________ __________
NY residents please add applicable sales tax for personal care products __________
SHIPPING AND HANDLING..... (see below)
*Outside the Continental USA, please refer to instructions below
__________
IF C.O.D., ADD $4.75 __________
Amount Enclosed.......... Make Check or Money Order payable to C.&J.N. INC. __________

 

UPS Shipping and Handling Rates (Effective 10/25/02)

Method: UPS Ground  
Delivery Time: 3 to 8 business days  
If your order total is: Your shipping charge is: Handling charge:
0-$15.00 $4.95 $1.00
$15.01-$30.00 $5.95 $1.00
$30.01-$50.00 $7.95 $1.00
$50.01-$75.00 $9.95 $1.00
$75.01-$100.00 $12.95 $1.00
$100.01-$125.00 $14.95 $1.00
$125.01-$150.00 $16.95 $1.00
$150.01-$200.00 $18.95 $1.00
over $200.00 8% of order $1.00

 

You can fax form to Fax: 718-421-5227
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