Merchandise Order Form (11-30-99)

Questions?   Email: Amoreva@aol.com   Phone: (804) 730-1712

 Name:                                                                            Email Address:

NOTE: A physical street address must be provided for shipment. Delivery is not available to a Post Office box!!!!!

Physical Street Address *:                                                   City:                                  State:                               Zip:

Item #

Item - Description

Size

Color

Quantity

Price Each

Total

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

Credit Card Information:

Merchandise Total

 

Card Type (circle one): Visa     Mastercard    Discover     American Express

VA Residents (add 4.5% Sales Tax)

 

Card Number:

Subtotal

 

Expiration Date (month/year):

Shipping (see chart)

 

Name of Cardholder:

TOTAL

 

Signature of Cardholder:

 

 

 Standard Shipping Charges by UPS Ground    (effective 11-99):

$0 - $20.00...........................................$6.99

$20.01 - $40.00....................................$7.99

$40.01 - $60.00 ...................................$8.99

$60.01 - $80.00 ...................................$9.99

$80.01 - $100.00 .................................$10.99

$100.01 - $120.00 .............................$11.99

For orders over $120.01 and/or to inquire about expedited service, call us at (804) 730-1712 (10:00 a.m. - 7:00 p.m. Monday through Friday and 10:00 a.m. - 6:00 p.m. Saturday.