Order Form
Please print, fill
out, and mail with your check to:
Jacqueline
Originals, 9272 Clydesdale Road, Castle Rock, CO 80108
Information: Call 303-246-5136;
FAX: 303-790-7675
Email:
jackie@n6media.com
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ORDERED
BY: |
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DROP
SHIP TO: |
If
different from 'ordered by' |
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No extra charge |
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NAME |
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NAME |
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ADDRESS |
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ADDRESS |
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CITY,STATE,ZIP |
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CITY,STATE,ZIP |
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Email |
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PHONE |
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PHONE: |
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Hand-written Enclosure
free: |
Please
print your message: |
PLEASE EMAIL ME WHEN YOU
HAVE SENT YOUR CHECK SO I CAN CONFIRM RECEIVING IT.
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QUANTITY |
SIZE |
DESCRIPTION
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PRICE |
TOTAL |
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FREE
PERSONALIZING: Please print |
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Charges
below are for the first "Ship to" address; paintings excluded.* |
*e-mail me or call shipping |
Total
Price of Items |
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(Personalizing
is free. |
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Total
Price of Items |
Priority Mail 2 days Shipping
& handling: |
Shipping
and Handling (see table) |
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$49.95 |
$7.95 |
TOTAL |
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$50.00-$75.00 |
$10.50 |
Delivery
in CO; add 4% sales tax |
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$75.01 - $100.00 |
$12.50 |
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Final
Total: |
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Thank you
for your order! Jacqueline
