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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