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Herbal Accents P. O. Box 937 Alpine, CA 91903 Because of potential liability problems, we are required to have this form signed and mailed to our offices before we will ship any hazardous material. HAZARDOUS MATERIAL WAIVER FORMYou must be 18 years or older to sign this form: Date:__________________________ Name: _________________________________________________ Company Name (If Applicable): ____________________________________ Address:________________________________________________ City, State, Zip: ______________________________________ Phone Number: _____________________ Birth Date: ____________________________ E-Mail Address: __________________________________________________ Material I am purchasing: ___________________________________________ I fully understand that the material I am purchasing is considered hazardous and could cause bodily harm. I assume all responsibility for its safe use and proper storage. I am at least 18 years of age. Signed: ___________________________________________ Please Print Name: ___________________________________________ Complete and sign this form and mail it to: |
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Copyright 1993-2010 Herbal Accents All
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