TCM FormulasTM
Personalized Chinese Herbal Formulas

Student Powder Order For Self

	Step 1: Who and Where
	Intern:	Your Phone #:	Formula #:
			(For quicker refills)
	If you are ordering a refill, do not use this form; instead, consult the help screen for quicker, easier methods.

	Shipping Information	Street Address	City
	Delivery to Me ($4.95) Pickup at PCOM SD	State	Zip code:

	Step 2: Duration and Daily Dosage

	The formula should last:	days
	The daily dosage is:	scoops	times per day
	which equals a total of:	g per day (automatically calculated).


	Step 3: Herbal Formula
Enter the original herbal formula (use as many spaces as you need and leave the rest blank) with their original dosages
Herb Formula Name: ( for quick refills!)

Herb		Dosage	Converted Dosage
1		g
2		g
3		g
4		g
5		g
6		g
7		g
8		g
9		g
10		g
11		g
12		g
13		g
14		g
15		g
16		g
17		g
18		g
19		g
20		g
21		g

Total grams		g


	4. Grand Total & Order

	Total Formula Cost:	$	If you change anything, be sure to click "Grand Total" again before ordering.
	Shipping Charge:	$
	Taxes Non-California Resident or Californian with Resale License California Resident %	$
	Click for	$

	Double check the whole form, and then click Order to email your order:		Your mail program may ask for confirmation- go ahead and send us the email. You will see a confirmation window pop-up; check to see if it opened under this window.