Name:
Address:
City/State/Zip:
where applicable
| Fast Action Internet Order | |||||
|---|---|---|---|---|---|
Name: | |||||
| Please print clearly. | |||||
| Item # | Qty. | Description | Color/Size where applicable |
Price | Total Amnt. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Merchandise Total | |
|||
|
Shipping & Handling | |
|||
|
Total Amount | |
|||
| Shipping & Handling Chart | |
|---|---|
| up to $14.99 | $4.95 | $15 - $19.99 | $5.25 | $20 - $24.99 | $5.55 | $25 - $29.99 | $5.95 | $30 - $34.99 | $6.75 | $35 - $39.99 | $7.75 | $40 - $44.99 | $8.75 | $45 - $49.99 | $9.35 | over $50 | $9.75 |
|
Send a catalog to a friend! |
Enclosed is the full amount of my order: $__________ Paid by: [check one please] __Check __Money Order __Credit Card (make checks and money orders payable to Alan Fuller) CHARGE this order amount to my __MasterCard __Visa __American Express __Discover Charge Card #:_________________________________________ Card expiration date:__________/__________/__________ Signature:________________________________________ |