Name: |
|
Address: |
|
City/State/Zip |
|
email: |
|
Phone: |
Item # & Description |
Color |
Size |
Price |
Qty |
Total |
SubTotal |
|||||
TX Residents Add 6.25% State Sales
Tax |
|||||
Shipping *see chart
below* |
|||||
Grand Total |
Visa, Mastercard, Discover & American Express
| |
Credit Card # |
|
Expiration Date |
|
Printed Name Exactly as it Appears on Credit
Card |
|
Cardholder's Statement Billing
Address
(Street Address, City/State/Zip
Code) |
|
Cardholder's Home Phone
# |
|
Signature of Card
Holder |
|
Last 3 digits on Back of
Card |
(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.
|
|||
$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 |