Please complete and print out the following order form to place your order.
Mail or fax completed forms to:

Fountainhead Farms
P.O. Box 37
Buckhorn, ON, Canada,
K0L 1J0

Fax:
1 (705) 657-1100
Telephone:
1 (705) 657-8121

NAME:

TELEPHONE:

FAX:

E MAIL:

ADDRESS:

CITY:

PROV. / STATE:

COUNTRY:

POSTAL / ZIP:

PRODUCT

SIZE

PRICE

QTY.

TOTAL

Hand and Body Lotion

120 ml

$ 10.00

Face Cream

60 ml

$ 12.00

Foot Cream

60 ml

$ 12.00

Sports Rub

90 ml

$ 10.00

Lip Balm

15 ml

$ 4.00

Pure Emu Oil

90 ml

$ 25.00

Pure Emu Oil Glass Pump

60 ml

$ 20.00

Bath Soap

110 ml (approx)

$ 3.50

Gel Capsules

500 mg (90 capsules)

$ 30.00

Youth Renewed Book

274 pages

$ 20.00

* All prices are in U.S. funds
** Shipping Costs: Shipping is free if the order is larger than $60.00 otherwise a $6.00 charge applies.
More for non-continental North America

CREDIT CARD NUMBER:

EXPIRY DATE:

CARDHOLDER’S NAME:

SIGNATURE:

SUB TOTAL:

TAXES (Canadian residents only)

SHIPPING: (If applicable)

TOTAL:

VISA and MASTERCARD accepted.
Cheque and money order are also accepted. Please make payable to Fountainhead Farms.