New Customer Information Form
Welcome to Santana's Aroma Shop. Please read and fill out form.
Customer Number
*
When you ordered I gave you a customer number. If you dont remember it pleas message me before fill out form.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Birthday Month (ONLY)
*
Phone Number
*
Phone numbe is used for loyalty points for when you order off the website
Format: (000) 000-0000.
How do you get paid
*
Please Select
Weekly
Bi-weekly
Twice a month
Monthly
Next pay Date
*
-
Month
-
Day
Year
Date
Please pick how you would like to recieve your order.
*
Please Select
Pick-up
Shipping
Delievery - will be a $5.00 charge, if you are more the 10 miles away there will be $10.00 charge
Because we do soap, candles, lotions and ect. Please let me know if you or any oner in your household has any allergies to anything.
*
How did you hear about us?
*
Please Select
Google
Friend
Family
Facebook
Submit
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