Ship To:

Name:_______________________________

Address:_____________________________

____________________________________

Phone Number:_________________________
(Just in case we have any questions.)

Shipping & Handling Charge

Print this form and mail/fax it with your check, money order payment (made out to YankeeScents) or credit card info to:

YankeeScents
PO Box 336
Wells River VT 05081
Fax: 1-781-846-3089

[__] I wish to pay by credit card.
(Visa, MasterCard, Amex, Discover)s

Card type: _______________________________

Name on card: ____________________________

Card number: _____________________________

Expiration date: ____________________________

Card security code: _________________

Thank you for your order!