CUSTOMER FAX ORDER FORM
PRINT AND FAX TO: 1-780-584-2601
	HAGINA HERBAL MASSAGE, BODY OILS AND LOTIONS
	EUROCANA PRODUCTS LTD.
	BOX 4764, BARRHEAD, AB CANADA T7N 1A6
		TEL: 1-780-584-2599
		TOLL FREE: 1-866-584-2599
		CONTACT US AT: info@Hagina.ca
DATE:				MAILING ADDRESS:
NAME:
TELEPHONE #:
E-MAIL ADDRESS:
				POSTAL / ZIP CODE:
***FREE SHIPPING IN CANADA ON ORDERS OF $300.00 OR MORE***
					UNIT
QUANTITY	PRODUCT DESCRIPTION			SIZE	PRICE	$ TOTAL
	Hand Care Balm			240 ml	$          10.75
	Foot Care Balm			240 ml	$          11.35
	35-Herbal Body Oil			80 ml	$        17.20
	Japanese Mint Oil			20 ml	$          11.55
	Japanese Mint Oil			35 ml	$        19.65
	Sport Massage Oil			100 ml	$        12.95
	Sport Massage Oil			250 ml	$        23.80
	Light Massage Oil			100 ml	$          8.25
	Light Massage Oil			250 ml	$        16.55
	Plus shipping and handling
	(on orders under $300.00 Cdn.)
	VISA #:				Sub-total	$_________
	Expiry date:
					GST	$_________
	MASTERCARD #:
	Expiry date:				TOTAL	$_________
	PLEASE USE THIS FORM WHEN ORDERING BY FAX.
	Prices subject to change w/o notice.