![]() |
Ordering Information |
| Your Name: | Phone No.: |
| Address: |
| City: | State: | Zip Code: |
| E-mail address or Fax Number (for order confirmation and amount due): |
Example: 2 yds. or 1 gross |
Each |
||||
| Please circle one: Mastercard VISA Am. Express Discover | |
| Card #: | Expir. Date: |
| Signature: |
| Order Total: | Shipping Charges: |
Order Total: | Shipping Charges: |
Merchandise Total: | $ |
| $10.00 or under | $30.01 to $40.00 | Shipping Charges: | $ | ||
| $10.01 to $20.00 | $40.01 to $50.00 | Add'l. Insurance (We can tell you if this is needed) |
|||
| $20.01 to $30.00 | $50.01 and over | Includes Insurance |
Total Remitted: | $ | |