Coconut Coast Natural Products
Handmade Soap Co.
P.O. Box 1173
Kapaa, Kauai, Hawaii 96746
Fax: (808) 822-0350
Name:__________________________________
Address:________________________________
City:___________________________________
State:__________________Zip:_____________
Telephone:______________________________
E-Mail:_________________________________
Please print out this form and
fax or mail it to us at the
above address.
Quantity
 
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Description
 
Cinnamon Soap
Kauai Rose Soap
Lavender Soap
Lemongrass Soap
Oatmeal Soap
Peppermint Soap
Pikake Soap
Plain Unscented Soap
Plumeria Soap
Green Tea Bath Salts          8 oz. package
Lavender Bath Salts            8 oz. package
Pua Keni'keni Bath Salts     8 oz package
Price
 
$3.95
$3.95
$3.95
$3.95
$3.95
$3.95
$3.95
$3.95
$3.95
$4.95
$4.95
$4.95
 
Subtotal
*Shipping
Total
Total
 
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*Shipping will be added to your order based on the weight of the items ordered.  
 
Method of Payment:
Check___     Visa___    MasterCard___  AMEX___ 
Card No.________________________ Exp. Date____________CVC*______
Name on Card________________________________________
Billing Address________________________________________
City_____________  State________  Zip Code______________
Signature____________________________________________

*MasterCard and Visa three digit CVC number is found on the signature panel on back of the card. American Express four digit CVV number is located above the R/H end of the embossed card number on the face of the card.
 
 
Mahalo for your order!

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