Name: |
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Title: |
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Organization: |
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Mailing Address: |
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Phone Number: |
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Fax
Number: |
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E-mail address: |
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Order Blank |
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Quantity |
Item
# |
Page
# |
Description |
Price |
Total |
1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
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|
10 |
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Sub-Total |
|
In CA. Appropriate Tax |
|
Shipping (see chart below) |
|
Total |
|
Note:
For Additional items, please attach your list on a separate piece of
paper. |
Special order merchandise and merchandise that is embossed or
engraved may not be returned. |
Please Include Shipping & Handling as Follows: |
|
If
order is up to $5.00 add |
$ 2.95 |
Full
Payment Enclosed - Check or Money Order |
o |
If
order is up to $10.00 add |
$ 3.95 |
Please charge my credit card: |
|
If
order is up to $20.00 add |
$ 4.95 |
Visa |
o |
If
order is up to $30.00 add |
$ 5.95 |
Master
Card |
o |
If
order is up to $50.00 add |
$ 6.95 |
American Express |
o |
If
order is up to $75.00 add |
$ 7.92 |
Discover |
o |
Over
$75.00 add |
$ 8.95 |
Card
Number: |
Add
$7.00 extra for registered Mail |
|
Expiration Date: (month / year) _________/_______ |
Credit Card
Minimum Order $10.00 |
Credit Card
Signature: |