[ ORDER FORM FOR CASH, MONEY ORDERS, or CASHIER'S CHECKS ]

I certify that I am at least 18 years of age and have read
and agree to all of SalviaWorld.com's Terms and Disclaimer
located at http://www.salviaworld.com/conditions.php


X___________________________________       ______________
  Signature                                 Date


Send completed order along with total payment to:
      Salvia World
      PO Box 2400 #D-41
      Virginia Beach, VA 23450


Name___________________________________ Age______


Ship-To Address__________________________________


City_____________________ State______ Zip________


E-mail___________________ Phone(____)____-_______
                  

Shipping and handling: 	United States [  ] $6.00
                       	International [  ] $12.00


PRODUCT                  PRICE     QTY.   TOTAL

______________________   $______ x ____ = $______


______________________   $______ x ____ = $______


______________________   $______ x ____ = $______


                                 SHIPPING $______


                              ORDER TOTAL $______