EMMR Gift Catalog Order Form
Print
this form, then be
sure to give complete descriptions
& check your order.
**SHIP TO**
Name:__________________________________________________
Street:__________________________________________________
City: _________________________ State:_______ Zip:__________
Phone:(_______)______________ e-mail:____________________
*Checks & Money Orders Payable To “EMMR”*
Check No._______________ Money Order No._______________
Visa/Master Card No.______________________Expires______
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QTY. |
Description & Size |
$ Each |
$ Total |
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| Sub Total | |||
| SALES TAX 6% [PA Residents Only] | |||
| SHIPPING CHARGES [See Below] | |||
| TOTAL REMITTED |
MAIL
ORDERS TO: Deb Wright, 80 Juniata Pkwy. East, Newport, PA 17074
| Shipping Charges | |
| Purchase Total | Shipping Charges: |
| $0.01 to $25.00 | Add: $3.95 |
| $25.01 to $50.00 | Add:
$4.95 |
| $50.01 to $75.00 | Add:
$5.95 |
| $75.01 to $100.00 | Add:
$6.95 |
| $100.01 to $125.00 | Add: $7.95 |
| $125.01 to $150.00 | Add:
$8.95 |
| $150.01 and above. | Add: $9.95 |