MAIL ORDER FORM

Credit card No.__________________ Exp. Date ______________________ MasterCard or Visa Please make check payable to: Suzanne Jonas

Billing Info from Credit Card Nane_________________________________________ Sreet_________________________________________ City State Zip________________________________   Phone________________________________________

Req By	Shipped on:	Ship Via

 

Quantity	Description		Unit Price	Total

Shipping up to $40: $4.25 $40.01 to $100: $7.00 $100.01 to $200: $11.00 $200.01 to 300: $15.00 above $300: free Shipped to a Tennessee address add 9.25% sale tax.

Subtotal   Shipping   Sale Tax   Balance Due

Ship to (if different from billing info) Nane_________________________________________ Sreet_________________________________________ City _________________________________________ State___________________Zip__________________   Back