ORDER FORM
| ---------------------------Item # /Description (if more lines are needed please write on back) --------------------------------------- | Price | Qt |
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| $.01 to 69.99 add $6.00 | total of merchandise | $ |
| $70.00 to up add $10.00 | <<<Shipping from chart | $ |
| Subtotal: |
$ | |
| NY residence add 8% sales tax |
$ | |
| Total due |
$----------------------- |
Please make check, MO or cashier check payable to: Patricia Kristoffersen
| Your name: | ---------------------------------------------------------------------------------------------------------------- |
| address: | |
| UPS street address: | |
| City, State, zip: | |
| phone: | |
| email address: |