WHOLESALE Order Form

Company Name _____________________________________________________ Tax ID #______________________________

Ship To Address: __________________________________________________________________________________________

Phone __________________________________Fax: ______________________Email: _________________________________

Form of Payment in U.S. Dollars (check one):

____VISA     ____Mastercard     ____Check   ____ Money Order

Credit Card # ________________________________ Exp. Date ___________Name on Card _____________________________

Credit Card Bill To Address: _________________________________________________________________________________

Item # Description # of cases Unit/case Price/candle Extended
Price
________ _________________________ ________X ________X ________= ________
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Shipping/Handling ________
TOTAL ________

Unique Aromas
29 Mack Street
Batesville, AR 72501
Fax #: 870-307-0059
Phone: 800-373-7210		 Add 15% of total order for Shipping/Handling

Large order will ship by American Freight Way , C&L Carrier, Yellow Freight or CSE trucking.

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Unique Aromas Inc.
29 Mack Street, Batesville, AR 72501