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| Sold To: |
Ship To: (if different than
"Sold To") |
| Name_____________________________ | Name_______________________________ |
| Company__________________________ | Company___________________________ |
| Address___________________________ | Address____________________________ |
| __________________________________ | ___________________________________ |
| City_______________________________ | City________________________________ |
| State___________Zip_________________ | State___________Zip__________________ |
| Day Phone (_____)________/__________ | Day Phone (______)________/__________ |
| Item No. |
Description |
Qty |
Price |
Total |
| Merchandise Total |
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Method Of Payment:(Foreign Orders is U.S. Funds Only ) We accept AMERICAN EXPRESS,VISA, MASTERCARD, DISCOVER, CHECK or MONEY ORDER Please include credit card # and expiration date with charge orders : _________/__________/__________/___________ Expiration Date:__________/____________ Signature_____________________________________
|
Merchandise
Total |
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GA Residents
Add 7% Sales Tax |
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Shipping
Charges: |
||||||||||
$0 to $25.=$6.75 |
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$25.01
to $50=$7.75 |
||||||||||
$50.01
to $75=$8.75 |
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$75.01
to $100.00= $9.75 |
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$100.01 to $125.00=$10.75 |
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$125.01 to $150.00=
$11.75 |
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$150.01 to $175.00=$12.75 |
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| $175.01 to $200.00=$13.75 | ||||||||||
| $200.01 to $250.00=$14.75 | ||||||||||
| $250.01 - Up = $15.75 | ||||||||||
TOTAL |
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