|
Name __________________________________
Address_________________________________
City____________________________________
State___________________________________
Zip Code________________________________
Daytime Phone ( )_________________________
E-Mail Address __________________________
| SHIPPING |
| QUANTITY |
COST |
| 1 - 2 |
$2.00 |
| 3 - 5 |
$3.30 |
| 6 - 8 |
$4.10 |
| 9 - 12 |
$4.40 |
|
|