SHIP to name_____________________________________________
Address:__________________________________________________
City:________________________State:________Zip:________
CARDHOLDER Name_____________________________________________
Address:__________________________________________________
City:________________________State:________Zip:________
Daytime Phone:(________)_________-_______________
Evening Phone:(________)_________-_______________
Your EMAIL Address________________________________________
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Circle One |
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| Packing and Shipping Chart |
| These charges represent only a part of the actual costs.We'll pay the rest!.If your Order is..... |
| up to $24.99...............................add $6.95 |
| from to $25.00 to $34.99............................add $7.95 |
| from to $35.00 to $44.99.................................add $8.95 |
| from to $45.00 to $54.99..............................add $9.95 |
| from to $55.00 to $74.99................................add $11.95 |
| from to $75.00 to $99.99................................add $12.95 |
| $100.00 or over.................................add $15.95 |
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