ACS Herbal Tea Company

 Please Print a copy for you records

 This Orderform is 100% Secure and all information kept 100% confidential
 

For Snail Mail:   Make Check or Money Order Payable to:
ACS Herbal Tea Co.
PO Box 497
Monroe, Ohio 45050
        We accept these Major Credit Cards 

4cards1.jpg (11666 bytes)

   Please provide the following ordering information:
Just fill in the blank beside the item you want to order

For Credit Card verification purposes we must have the name as it appears on the card
 and the area code and phone number (no cell phones) associated with the card

Name  
Phone Number  
Street Address   Apt/Suite #
City  
State/Prov.  
Country  
Postal/Zipcode  
Quick Tea   Qty $17.95
Quick Capsules   Qty $19.95
THC MaxOut   Qty $69.95
10 Day Detox   Qty $34.95
BioWash   Qty $49.95
Randomizer   Qty $19.95
Eliminator (16 ounce)   Qty $19.95
Home Test Kit (1st substance)   
Home Test Kit (2nd substance)   
Shipping Options
Credit Card Number    
Expiration Date  
Email Address (required)  
Western Union Control #  

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Copyright ACS Herbal Tea Co. 1996/2005 All Rights Reserved.
Last revised: January 10, 2008.