Please note that by purchasing through the Auto Ship Program you are authorizing Earth Touch Inc. debit your credit card for the total amount of this order each month.  The product will be sent directly to the shipping address you give below about every 30-32 days.

Product Order Form
Quantity	Item	Special Price	Shipping & Handling
	Earth Touch Essentials -- 90 Tablets (Minimum requirement of 2 bottles per month for Auto Ship)	$10.00 ea	Free(with Auto Ship Order)
Sales Tax of 6.225% will be charged on all orders from MO residents.

Billing Information
*Card Type: American Express  MasterCard Discover                 Visa	*Credit Card Number:       *Expiration Date: (MM/YY)                *Card Code:
*Full Name on Card:             *Daytime Phone:                 Company:                Home Phone:                      *Email                              Fax:
*Address Line 1:           Address Line 2:                   *City:     *State:             * Postal Code:     *Country:

Shipping Information

*Contact Name:                 Company:   *Address Line 1:          Address Line 2:                   *City:     *State:          *Postal Code:     *Country:

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