Mail Order

CountrysCharm Order Form

Print off this page and then fill it out. Send it to:

CountrysCharm
P.O. Box 54
Swea City, IA 50590

Send Check, money order or use paypal.
Be assured that your order will be processed quickly and securely.

Name:

Mailing Address:

City: State: Zip Code:

(Optional) Phone Number:

E-Mail Address:

Would you like these product shipped to a different address than is listed above?

Name:

Mailing Address:

City: State: Zip Code:

(Optional) Phone Number:

Please write or type your requested items below:

Item	Scents	Size	Quantity	Price	Total








Shipping Charges
Grand Total:

Please note the following shipping charges:

$0-25.00	$3.00
$25.01-40.00	$7.00
$40.01-100.00	$10.00
$100.00-150.00	$13.00

Please make the check or money order for exact amount. Send your order to:

CountrysCharm
P.O. Box 54
Swea City, IA 50590.

If you have any questions you can contact us toll-free at 1-877-460-4405.

THANK YOU FOR YOUR BUSINESS!