Lotus Immortal Product Order Form 

 Tools for the Expansion of the Human Experience  

                                                                                                                                                                   

 Please fill in the necessary information for your order, copy and paste and email this document to lotusimmortal@yahoo.com   You will then be sent a request for payment by Lotus Immortal, which will include the shipping charges, through PayPal/Credit Card or asked to mail a money order or check.

 

  ITEM NUMBER

 

 

Description of Product

 

Quantity

 

Total Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

         

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total amount including shipping

      $      

                   Upon receipt of your PayPal or Credit Card payment, check, money order, or International Money Order you will be notified by email of the time of the shipment of your order and any other details, to your address (please make International orders in US dollars only). If you have any questions do not hesitate to ask. Email us at Lotusimmortal@yahoo.com

Your Name  :

E-mail  : 

                         
Street address and Apt.# :              

City  :               

State (province)  :

Country  :

Zip code  :