Billing

First name *

Last name *

Company name (optional)

Country / Region *

Street address *

Apartment, suite, unit, etc. (optional)

Town / City *

State *

ZIP Code *

Phone *

Email address *

First name *

Last name *

Company name (optional)

Country / Region *

Street address *

Apartment, suite, unit, etc. (optional)

Town / City *

State *

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Order notes (optional)

Product Subtotal

Mini Tea Sampler × 1 $6.00

Subtotal $6.00

Shipping	Flat rate: $10.00

Total $16.00

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