(For personal checks or money orders)

Please print this page out and mail it to the address at the bottom of the page.

www.BuckwheatTherapy.com

                                                                                                                                          Amount x Quantity =          

Aromatherapy Buckwheat Pillow King (19in x 34in/ Continental US)                         $65.99 x   __________=   _________

Aromatherapy Buckwheat Pillow Queen (20in x 26in/ Continental US)                     $55.99 x   __________=   _________ 

Aromatherapy Buckwheat Pillow Standard (19in x 24in/ Continental US)                 $47.99 x   __________=   _________

Aromatherapy Buckwheat Pillow Twin (15in x 18in/ Continental US)                        $41.99 x   __________=   _________

Aromatherapy Buckwheat Pillow Travel (11in x 15in/ Continental US)                      $29.99 x   __________=   _________

Aromatherapy Buckwheat Pillow Travel (11in x 15in/ Continental US)                      $34.99 x   __________=   _________

                 * (with Pillow Case)

Aromatherapy Buckwheat Pillow U-Shaped Travel (11in x 15in/ Continental US)  $29.99 x   __________=   _________

Aromatherapy Sachets:

Lavender Sachet (Two full cups of dried lavender flowers)                                          $7.99   x   __________=   _________

Chamomile Sachet (Two full cups of dried chamomile flowers)                                $7.99   x   __________=   _________

BuckwheatCo. Blend Sachet

(Two full cups of dried and mixed chamomile and lavender flowers)                         $7.99   x   __________=   _________

TOTAL Enclosed (check or Money Order)                                                                          ________

Includes FREE shipping within the continental United States: (No PO Boxes, please)

Please send my order to:

Name:                      ___________________________________________________________

Address:                  ___________________________________________________________

City, State, Zip:           ____________________________________________________

 E-mail:                     ___________________________________________________________

Phone Number (only for orders outside of the continental United States):                        

                                ____________________________________________________________

Please send check or money order to:

BuckwheatCo.

154 West Avenida Del Rio

Clewiston, FL 33440

THANK YOU!