Mail Order Form
27101 East Oviatt Rd. Bay Village, OH 44140 - (440) 871 - 5150
Print this form to use when mailing in your order to us.
|
(A) Sold To:(Your name and address)
Name: ______________________
E-mail: ______________________
Address: _____________________
_____________________________
City:________________ State:___ Zip:_____
Daytime Telephone:_______________________ |
(B) Ship To:
Name: _______________________________ Address: _______________________ _______________________________ City:________________ State:___ Zip:________ Delivery Address Telephone:_________________ |
(C)Gift items:
| Item #: | Item Name: | Quantity: | Price per Item: | Total: |
| _____ | _____________________ | ____ | _______ | _______ |
| _____ | _____________________ | ____ | _______ | _______ |
| _____ | _____________________ | ____ | _______ | _______ |
| _____ | _____________________ | ____ | _______ | _______ |
| _____ | ____________________ | ____ | _______ | _______ |
(D)Totals, Taxes, Shipping:
| Merchandise Total:________ | |||
| Ohio Residents: add 7.75% Sales Tax:________ | |||
| Shipping (see chart):________ | |||
| purchase amount: | shipping: | ||
| up to $10.00 | add $5.45 | ||
| $10.01-$14.00 | add $5.95 | ||
| $14.01-$18.00 | add $6.95 | ||
| $18.01-$25.00 | add $8.95 | ||
| $25.01-$45.00 | add $9.95 | ||
| $45.01-$85.00 | add $10.95 | ||
| $85.01-and up | add $12.95 | ||
| TOTAL:_______ | |||
(E) Payment Method:
___ American Express ___ MasterCard ___ Visa ___ Discover
Credit card #___________________________________________ & exp. date:____________
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