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Name: |
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Street Address: |
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City/State/Zip |
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email: |
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Phone: |
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Item # & Description |
Color |
Size |
Price |
Qty |
Total |
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SubTotal |
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TX Residents Add 6.25% State Sales
Tax |
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Shipping *see chart
below* |
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Grand Total |
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Visa, Mastercard, Discover & American Express
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Credit Card # |
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Expiration Date |
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Printed Name Exactly as it Appears on Credit
Card |
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Cardholder's Statement Billing
Address
(Street Address, City/State/Zip
Code) |
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Cardholder's Home Phone
# |
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Signature of Card
Holder |
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Last 3 digits on Back of
Card |
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(For all PayPal orders, we will send you a PayPal invoice after we recieve your order form.)
Shipping:
Insurance is
available, add $ 6.00.
Personal checks are accepted, however there will be a
slight delay in shipping as the items will not ship until the funds have cleared
the bank.
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| $0.00 - $50.00 | $5.50 | ||
| $51.00 - $100.00 | $9.50 | ||
| $100.99 - $150.00 | $13.50 | ||
| $151.99 - $300.00 | $19.95 | ||
| Over $300.00 | 13% of order total | ||