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Order Form - 07/00
BAYOU SAINT JOHN PRODUCTS/
RAVEN PSYCHIC CENTER
P.O.Box 1, Lafferty, OH 43951
Telephone: (740) 968-3366
Email:ravenpay@1st.net

No C.O.D. 1st time ordering: send money order or cashier's check.
Minimum order is $10.00. ~ 10% Discount on orders over $50.00.
We accept Master Card/Visa - Min. credit card order is $20.00.
Account #:|__|__|__|__|-|__|__|__|__|-|__|__|__|__|-|__|__|__|__|
Expiration Date ~ Mo.:|__|__| Yr.:|__|__|
PRINT NAME as it appears on card: _____________________________________
Name: _______________________________________ 
Address: ____________________________________ 
City: ____________________ St./Prov.: ______ Post./Zip Code: _________
Telephone: __________________________ Date: _______________
|Qnty. | Item # | Description | Cost | Total |
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Added Shipping & Insurance |Sub-Total $________|
Domestic Shipping = $5.00 |Discounts -________|
$20.00-$50.00 = $1.00 | " -________|
50.01-100.00 = 1.50 |Tax (6.5% OH only) ________|
100.01-200.00 = 2.50 |Ship.& Handling ________|
Over $200.00 = 3.50 |Insurance ________|
|Total Due $________|
-Amt. Paid $________ = Amount Due $________|

Signed: ______________________________________ Date: _______________