Bless Your Heart Therapeutic Pillows™
"Comforting Patients on the Road to Recovery"
6640 Clybourn Ave., Suite 66
North Hollywood, CA 91606-5205
(818) 980-7561 (fax/phone)
www.blessyourheartpillows.com

Please complete this form and mail, fax as indicated above, or e-mail to tina@blessyourheartpillows.com. Be sure to include name, address and payment option desired prior to faxing or mailing. Items will not be manufactured unless signed below confirming your order and acknowledging your obligation to pay for order. Payment is due 30 days from receipt of merchandise. If you would like your hospital/facility logo silkscreened below heart diagram, please e-maill your logo to tina@blessyourheartpillows.com. Note: $50.00 additional one-time charge for silk screening one color facility name and logo below diagrams. $70.00 additional one-time charge for silk screening two color facility name and logo below diagrams.
$25.00 additional fee if artwork requires editing. (email image as .eps, .pdf or .jpg file w/dpi of at least 300). Shipping and handling charges not included. State and local sales tax not included.

We accept PayPal payments! Checks preferred. Orders of 50+ require 1/2 of total deposit for new clients.
Now Available for International Users
I accept PayPal, the #1 payment service in online auctions!



Company Name if Applicable

Items for Resale?


Yes               No

CA State Tax Permit #

Buyer's Last Name:

First Name:

Area Code     Telephone

Area Code        Fax Number

Street Address

Shipping Address (if different)

City

State/Zip Code

City

State/Zip Code


Item # Product Description Color/Back or Description Price Per Quantity Total Cost
101 Cardiac Travel Pillow
BEST SELLER!!!		 With or without Diagram
Red w/White Diagram/Text & Blue Back		 $14.50 (200+)
$16.50 (50+)
$20.00 (indiv.)		    
102 Cardiac Travel Pillow w/Marker Red w/White Diagram/Text & Blue Back $15.50 (200+)
$17.50 (50+)
$21.00 (indiv.)		    
103 Incision Pillow White w/Red and/or Pink Hearts $ 5.00 (50+)
$ 9.50 (indiv.)		    
104  Loyal Lion Coughing Pillow  Specify (a), (b) or (c) $17.50 (50+)
$22.50 (indiv.)		    
105  Post-Hysterectomy/Abdominal Surgery Travel Pillow
2ND BEST SELLER!!!		 Specify floral or solid colors (brown, gray or black). $13.50 (50+)
$17.00 (indiv.) 		    
106 Post-Surgery Travel Pillow Specify floral or solid colors (brown, gray or black). $22.00 (50+)
$18.00 (indiv.)		    
107  Post-Breast Surgery Pillow  Specify breast cancer fabric or may be used for post-cardiac care in brown, gray or black. $16.50 (50+)
$21.50 (indiv.) 		    
107  Get Well Box  Specify (a) or (b) $23.00 (25+)
$28.50 (indiv.)		    
108  Aromatherapy Eye Pillow  Specify (a), (b), (c) or (d). Custom order also available. $12.00    
109  Aromatherapy Neck Pillow  Specify (a), (b), (c) or (d). Custom order also available. $18.00     
110 Aromatherapy Throw Pillow  Specify (a), (b) or (c). Note: Color scheme of your choice available. (Example: lavender, cream and green fabrics shown). $12.00
$ 8.00
$ 4.00 		    
           
           
*Note: 50+ quantity price provided to hospitals and/or medical facilities.

Payment Type:   Personal Check _____ (note item(s) will not be made and shipped until check clears). Cashiers Check_____    Money Order_____Paypal______
Accepted Credit Cards [MC] [Visa] No.____________________ Exp. Date____ Issuing Name and/or Credit Card Billing Address (if different than above) ___________________________

Sub-Total Cost

 

Shipping:
$7.00 for each individual pillow
$50 for orders of 50
(Other than individual or 50, shipping will be calculated once order received)

Shipping Cost

 

By signing below, I (we) acknowledge that upon receipt of this order form by Bless Your Heart Therapeutic Pillows ™, preparation of the above order will commence, and I (we) am (are) obligated to pay for the items ordered.

 

California State and North Hollywood District Sales Tax 8.25%  

   

Signature:                                      
email address

Date:

Estim. Total Charges

 

Home