ORDER

ONLINE     : www.essentiallyaroma.com
BY EMAIL  : consult@essentiallyaroma.com
                 : orders@essentiallyaroma.com
BY PHONE : 91- 44 - 25323486 / 31014898
BY FAX      : 91- 44 - 26433787

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DATE                : dd mm yr

ORDERED BY  
                     
NAME               :

ADDRESS         :

POSTAL CODE :
TELEPHONE     :
MOBILE            :
FAX                  :

DELIVERY ADDRESS

IF SAME AS ABOVE 

IF DIFFERENT PLEASE FILL THE DETAILS BELOW

NAME                 :

ADDRESS           :

POSTAL CODE   :
TELEPHONE       :
MOBILE              :
FAX                    :

__________________________________________________________________________

CODE NO           QTY                DESCRIPTION           UNIT PRICE      TOTAL VALUE
                               
                               
                               
                               
                               

                                                              Please add Courier charges * 
                                                                                                   Total  

* For orders upto Rs.500/-, delivery charges will be Rs.50/-
* For orders above Rs.500/- and below Rs.1,000/-, delivery charges will be between
  Rs.75/-

INTERNATIONAL BUYERS
- Please convert the Indian Currency @ Rs.48.50 per USD
- Please check for the postage charges for your country with us.
- Pease let us know if you prefer a specific courier company.

__________________________________________________________________________

YOUR PAYMENT DETAILS (Please indicate which)

D.D should be made in favour of "ESSENTIALLY AROMA"
Credit Card or Debit Card - Visa / Master Card / Visa Electron / Cirrus /
      American Express

Please fill in Card Holders Name and Address if different from above.

IF SAME AS ABOVE                      
IF SAME AS DELIVERY ADDRESS 

NAME                 :

ADDRESS           :

POSTAL CODE   :
TELEPHONE       :
MOBILE              :
FAX                    :

Note: Data Protection Assurance: Please e-mail us your credit card number and validity. We do not make your name and address or other details available to any other company. Your credit card details are not recorded on computer. We keep your confidentiality.

THANK YOU FOR YOUR ORDER!