Custom Blend Order Form from Lightning Gap Farm and Botanical LLC

Custom Blend Order Form from Lightning Gap Farm and Botanical LLC

Use this form to select your custom blend choices. Once you click submit, you will be redirected back to our site to complete your order and pay. We will not begin working on your order until we have received payment. All custom blends are 2FL OZ and come in an amber glass bottle with a graduated dropper cap.
Name*

First NameLast Name
Email*
example@example.com
Do you have a reorder code that you would like to use?

YesNo
Please input reorder code:*
Are you...

Filling out this form for myselfFilling out this form for a client
Are you ordering a blend that your herbalist has already sent in to us?

yesno
Your Herbalist's Name*

First NameLast Name
Client name as it will appear on their order*

First NameLast Name
NOTE: Please provide percentages in increments of 5% or 10% and make sure your total adds up to 100%!

Example: You may select

Herb #1 selection: goldenseal root
Herb #1 percent in blend: 40%
Herb #2 selection: black walnut hull
Herb #2 percent in blend: 35%
Herb #3 selection: red clover flower
Herb #3 percent in blend: 25%

to order a custom blend that is 40% goldenseal root, 35% black walnut hull, and 25% red clover flower.
Select Herb #1*
Herb #1 percent in blend*
Select Herb #2*
Herb #2 percent in blend*
Select Herb #3
Herb #3 percent in blend*
Select Herb #4
Herb #4 percent in blend*
Select Herb #5
Herb #5 percent in blend*
Should be Empty: