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Herbal Information Center Mail Order Form
(http://www.kcweb.com)

GIC Inc., - Herbal Information Center
1429 Navigator Rd.
Punta Gorda, FL 33983

Please complete this order and  mail with payment to the above address.

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Shipping Information
Email : ____________________________________________
Name : ____________________________________________
Address 1: _________________________________________
Address 2: _________________________________________
City : ______________________________________________
State : _____________________________________________
Postal Code : _______________________________________
Country: ___________________________________________
Phone : ___________________________________________
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Billing Information
Payment Type : VISA _____ Master Card _____ Check _____
Card Number: _________ _________ _________ _________
Expiration Date: (mm/yy) : ____ ____
Name as it appears on card: _____________________________
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Product Order

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Catalog #: (example: C05STJO) _________________________

Quantity: _________ Size: ___________ (example: 100 Tabs)

Price: $ ___________

Description: _________________________________________

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Catalog #: (example: C05STJO) _________________________

Quantity: _________ Size: ___________ (example: 100 Tabs)

Price: $ ___________

Description: _________________________________________

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Catalog #: (example: C05STJO) _________________________

Quantity: _________ Size: ___________ (example: 100 Tabs)

Price: $ ___________

Description: _________________________________________

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Summary Information
Product Total = $___________

+ Shipping = $_____________

= Grand Total = $___________

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U.S. Shipping and Handling
$1.00 - $15.00 ….. add $3.00

$15.01 - $30.00 ….. add $3.75

$30.01 - $65.00 ….. add $4.25

$65.01 or more ….. FREE

Make Check Payable to GIC Inc.

International customers please use the international shipping tables available from our web site.


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