Name:_____________________________________________________________
Street Address:______________________________________________________
City:______________________________________ State:___ Zip:________-____
Credit Card Number: _____________________________Expiration Date: ___/___
E-Mail:_____________________________________________________________
| Description | Size | Color | Amount | Qty | Total | ||
| 1 | |||||||
| 2 | |||||||
| 3 | |||||||
| 4 | |||||||
| 5 | |||||||
| 6 | |||||||
| 7 | |||||||
| 8 | |||||||
| 9 | |||||||
| 10 |
| From Amount: | To Amount: | For USA Add: | For Canada Add: | For Foreign Add: |
| 0 | $50.00 | $5.00 | $7.50 | $10.00 |
| $50.01 | $100.00 | $6.00 | $9.00 | $12.00 |
| $100.01 | $200.00 | $8.00 | $12.00 | $16.00 |
| $200.01 | $300.00 | $10.00 | $15.00 | $20.00 |
| $300.01 | up | $12.00 | $18.00 | $24.00 |
Last Updated July 08, 2000
© Copyright 1996 MR Inc.
Webmaster: Click Here To Email Robin