BIGHORN BOTANICALS, INC

                         113 Pilgrim Creek Rd    Noxon, MT  59853     PH: 406-847-5597   FX: 406-847-5502   
Toll Free:   888-847-1223    Email:  nox5597@blackfoot.net

www.bighornbotanicals.com

RETAIL ORDER FORM
 

DATE:  ________________________ PH: _________________________________________________


Cell:___________________________ Email: _______________________________________________

NAME: ___________________________________________REFERRED BY: _____________________

ADDRESS: ___________________________________________________________________________

 
VISA, MASTERCARD, DISCOVER #____________________________________________________

EXP DATE: ________________ CODE # __________________



Montana YewTip Products
(Taxus brevifolia)

QUANTITY                                                                                                                             TOTAL


__________TEA, loose,  1 lb bag …... …………………………………@ $   46.50= _________________

 

__________TEA BAGS,   24 per pkt …………………………………. @      10.45 = _________________

 

__________TINCTURE,  Fresh 1:1.7
______________1 oz  bottle w/dropper ..………………………………..@      12.65 = _________________

______________4 oz bottle ……………………………….……………..@      41.50 = _________________

_____________16 oz  (1 pint)  …………………………………………...@   146.00 = ________________

 

__________OIL,  Fresh 1:1.7

_____________2 oz  bottle w/dropper …………………………..……. @      31.50 = __________________

_____________4 oz bottle ………………………………………………@    60.25 = _________________

 

__________SALVE, 1 oz  jar ..…………………………………………@    14.75 = _________________

__________ SALVE, 2 oz jar ..………………………………………….@    27.00 = _________________

 

__________CAPSULES, 180 per bottle/ 300 mg ……..………………@   46.50 = _________________

 

__________ SOAP, 4 oz bar ……………………………………………@      8.20 = _________________

 

__________LOTION, 5 fl oz dispenser bottle (Natural) ..……………..@    16.75 = _________________
 

__________LOTION, 5 fl oz dispenser bottle (Floral Fragrance)…......@    16.75 = _________________

 

 

__________ LIP BALM, tube …………………………………………….@    5.25=  ________________   

 


SUB-TOTAL   $_________________


Shipping  $_________________


TOTAL   $ ________________

 

DATE SHIPPED: ______________ CARRIER: _______________

 

(Office use: PTS ______________ PTI _________________) rev 9/14/07