PAYMENT FORM FOR JASMINES SANCTUARY

Please charge my:

Visa ( ) MasterCard ( ) Amex ( ) Debit Card ( ) or other Credit Card

Card No: ____________________________

Exp date: ___________________________

Signature: __________________________

MY PERSONAL INFORMATION

Name: _____________________________

Address: ____________________________

City: _______________________________

Province/State: _______________________

Country: ____________________________

Phone: _____________________________

Email: _____________________________

Fax: _______________________________

  • we need your phone or email in case we have
  • any questions about the order. Information is always kept private for your safety.
  • cheques, drafts, or money orders can be mailed to P.O. Box 314, Chalk River, Ont. K0J 2J0
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