| ITEM # | QTY | DESCRIPTION | PRICE | TOTAL |
|---|---|---|---|---|
Shipping and Handling Charges |
Merchandise Total |
|||
ADD |
FOR ORDERS |
$ |
||
$5.00 |
Under $10.00 |
|||
$7.00 |
$10.00 to $49.99 |
Shipping Total |
||
$9.00 |
$50.00 to $99.99 |
$ |
||
$11.00 |
$100.00 to $199.99 |
GRAND TOTAL |
||
$13.00 |
Over $200.00 |
$ |
||
Shipping/Billing Information
Please allow two to four weeks for shipping
NAME: ________________________________________________________
ADDRESS: _____________________________________________________
CITY: __________________________________________________________
STATE: ________ ZIP CODE: ____________________________
COUNTRY: ________________________________
Payment Information:
CHECK PAYMENT METHOD
_____U.S. Check _____U.S or Intl. Money Order _____Visa _____Master Card
Credit Card #_____________________________________________
Expiration Date___________________________________________
Signature:__________________________________________