Chinese Herbs

Chinese Herbal and Special Products Order Form

CHINESE HERBAL AND SPECIAL PRODUCTS ORDER FORM FOR PAST CLIENTS

We want you to be able to continue to get herbs your horses/dogs need. If you wish to order, please fill out the form with complete information. If you are not in our data base, we will not be able to complete a special order. Please see the shop or the pharmacy buttons for all other products to order. Please allow time for us to process the orders, no rush orders will be accepted. Thanks.

Basic Client Info

First Name:
Last Name:
Country:
Phone Number:
By entering your phone number and submitting this form, you consent to receive marketing text messages (such as promotion codes and cart reminders) from Harmany Equine Clinic, Ltd at the number provided, including messages sent by autodialer. Consent is not a condition of any purchase. Message and data rates may apply. Message frequency varies. You can unsubscribe at any time by replying STOP or clicking the unsubscribe link (where available) in one of our messages. View our Privacy Policy and Terms of Service.

Billing Address

Street Address:
Address Line 2:
City:
State:
Zip Code:

Charge to credit card on file?*

Yes
No
(Do not submit new card info via the internet. We will call.)

Shipping Address (if different from Billing)

Street Address:
Address Line 2:
City:
State:
Zip Code:

Special shipping or address information

Order Description:
Patient's Name:
Species*:
Horse / Dog:
Herbal Formula Name:
Herb Form (powder, capsule, teapill, etc.):
Size of Container (90g, 100 capsules, 200 teapills, etc.):
Quantity:
Enter your email:

Thank you! Your order has been submitted.