Candle Home Shopping Network Order Form

Home Shopping Network Candle Order Form

Candle Home Shopping Network Order Form

Date

First Name

Last Name

Phone Number

If delivery address is the same as billing check box. If delivery and billing is different please complete billing address.

Yes, Delivery and Billing Address are the same.

Delivery Address

Address Line 1

Ste. #

City

State

Zip Code

Country

Cardholder Name

Credit or Debit Card Number

Expiration Date

CVV Code

Billing Address

Address Line 1

Ste. #

City

State

Zip Code

Country

CANDLE SCENTS

*Please note all candles are $13.75 + shipping - 10 oz. with a Clear Glass Jar Container and Wooden Lid with 2 wicks.

Shipping ranges $10.00 - $13.00 depending on your order size and we will notify you of the total billed.

List additional scents

Please specify the quantity and scent name for each candle ordered.

Additional Comments

By sigining this form, you are confirming that the order placed is accurate. All Wax Candle Company will ship your order to the shipping address listed. Please contact us within 24 hours of your initial order placement via email, or phone to make changes to recent orders. Thank you.

I have read and agree to the Privacy Policy and Refund/Exchange Policy.

I consent to have this website store my submitted information so they can process my order.

Total Amount To Be Billed: