Unfortunately, due to higher ingredient costs, the following rate increases will take effect 1/1/10. This supercedes all previous order forms. (Shipping within the U.S.A. only). PLEASE MAIL THIS FORM WITH PAYMENT TO: Dancing Madrone Soap Co., P.O. Box 434, Willits, California 95490 MAKE CHECKS PAYABLE TO: Dancing Madrone Soap Co.(Payment in USD) Name __________________________________________________________________ Address_________________________________________________________________ (City, State, Zipcode ) Contact Info _____________________________________________________________ (email & or telephone)______________________________________________________ MINIMUM ORDER: 3 ITEMS

CHOICE OF PRODUCTS Use back of form for additional items.
1. _______________________________________
2. _______________________________________PRICE INCLUDES SALES TAX (Calif.)
3. _______________________________________REG. SOAP-$4.00 PER BAR
4.________________________________________FACIAL SOAPS-$6.50/BAR
5. _______________________________________SHAVING SOAPS-$6.50/BAR OR ROUND
6. _______________________________________WINE SOAPS-$6.50/BAR
7. _______________________________________PEPPERMINT FOOT BUTTER - $4.00/TIN
8. _______________________________________SOLID LOTION BAR - $4.00/TIN
9. _______________________________________
10._______________________________________
11. ______________________________________ CALCULATE YOUR ORDER TOTAL
12. ______________________________________ Product Total_____________._____
13._______________________________________Shipping Total_____________._____
14. ______________________________________ Delivery Confirmation_______. 70
15. _______________________________________TOTAL DUE _____________._____

CALCULATING THE SHIPPING RATE:

Flat rate priority mail boxes used for shipping. Delivery confirmation required.

1. 3 to 6 items $4.95
2. 7 to 36 items $10.70
3. 37 to 72 items $14.50