(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 Body Pillow (19 1/2in x 60in)                                                 $124.99 x   __________=   _________

Aromatherapy Buckwheat Pillow King (19 1/2in x 36in)                                                    $67.99 x   __________=   _________

Aromatherapy Buckwheat Pillow Queen (19 1/2in x 30in)                                                $57.99 x   __________=   _________ 

Aromatherapy Buckwheat Pillow Standard (19 1/2in x 26in)                                            $49.99 x   __________=   _________

Aromatherapy Buckwheat Pillow Twin (16in x 19 1/2in)                                                    $43.99 x   __________=   _________

Aromatherapy Buckwheat PIllow Twin with white pillow case                                         $48.99 x  __________= ___________

Aromatherapy Buckwheat Pillow Twin with 2 white pillow cases                                    $53.99 x __________=___________

Aromatherapy Buckwheat Pillow Travel (12in x 16in)                                                         $29.99 x   __________=   _________

Aromatherapy Buckwheat Pillow Travel with pillow case                                                  $36.99 x   __________=   _________

                 * Please indicate color                                                                                            ______________________________

Aromatherapy Buckwheat Pillow Travel with 2 pillow cases                                            $41.99 x  __________=___________

               *Please indicate color                                                                                                _____________________________

Aromatherapy Buckwheat Neck Pillow  with pillow case                                                  $36.99 x   __________=   _________

                 *Please indicate color                                                                                              _____________________________

Aromatherapy Buckwheat Neck Pillow with 2 pillow cases                                             $41.99 x __________=____________

                *Please indicate color                                                                                              ______________________________

Aromatherapy Buckwheat Neck Roll Pillow with pillow case                                           $36.99 __________=_____________

                *Please indicate color                                                                                              ______________________________

Aromatherapy Buckwheat Neck Roll Pillow with 2 pillow cases                                     $41.99__________=_____________

               *Please indicate color                                                                                                _____________________________

Pillow Cases:

Body Pillow Case (White)                                                                                                         $19.99 x   __________=   _________

Twin Size Pillow Case (White)                                                                                                 $11.99    __________ = _________

Twin Size Pillow Cases (2)  (White)                                                                                       $17.99    __________ = _________

Travel Size Pillow Case (Please Select Color:   __________________ )                     $9.99   __________

Travel Size Pillow Cases (2) (Please Select Colors_______________)                      $15.99___________  = __________

Aromatherapy Sachets:

2 Lavender Sachets (Over 1 full cup of dried lavender flowers in each)                          $8.99   x   __________=   _________

2 Chamomile Sachets (Over 1 full cup of dried chamomile flowers in each)                $8.99   x   __________=   _________

2 BuckwheatCo. Blend Sachets

(Over 1 full cup of dried and mixed chamomile and lavender flowers in each)             $8.99   x   __________=   _________

Buckwheat Soap :

Buckwheat Soap                                                                                                                         $5.95   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:       ____________________________________________________________

Please send check or money order to:

BuckwheatCo.

398 East Lake Road

Penn Yan, New York  14527

THANK YOU!