Please press file and print page to print this order form. Mail or fax to
MYRA'S SHOP
6943 SW 152ND COURT
MIAMI -  FLORIDA, 33193
Fax: 1-952-400-4437
Please fill out form with "BLACK" ink for best results. THANKS!

SHIP to name_____________________________________________

Address:__________________________________________________

City:________________________State:________Zip:________

CARDHOLDER  Name_____________________________________________

Address:__________________________________________________

City:________________________State:________Zip:________

Daytime Phone:(________)_________-_______________

Evening Phone:(________)_________-_______________

Your EMAIL Address________________________________________

Item #
Description
Price Each
Quantity
Color/size
Total
           
           
           
           
           
           
           
 MYRA'S SHOP Order Form
 Sub-Total $
Shipping and Handling (See chart below)
S & H $
Thank you for your order!
 Grand Total $
Payment Method:
 Circle One
Money Order
Check
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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MYRA'S SHOP 6943 S.W. 152ND COURT MIAMI, FLORIDA 33193