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71 Main Street • Belfast, ME 04915 • Phone (207) 338-4045 • Fax (207) 338-5988
Print, fill out and fax or mail this order form.
| Bill To: | Ship To: (If different) |
| Name: | Name: |
| Address: |
Address: |
| Address 2: |
Address 2: |
| City | City |
| State | Zip |
State | Zip |
| Daytime Phone Number: | Fax Number: |
| Qty |
Item |
Description |
Price Each |
Shipping |
Total |
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SHIPPING AND HANDLING CHARGES
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Under $25:
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$5.95
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$25-$34.99:
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$6.95
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$35-$49.99:
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$7.95
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$50-$74.99:
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$8.95
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$75-$99.99:
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$10.95
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$100-$149.99:
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$12.95
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$150-$249.99:
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12%
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$250-$999.99:
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10%
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$1,000.00 and up:
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8%
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| Subtotal Items: |
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| Shipping Fees: |
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Add 5% for Sales Tax:
(Maine Residents Only) |
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| Total Due: |
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| Total Enclosed: |
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Payment Method: [ ] Visa [ ] Mastercard [ ] Discover
[ ] Check [ ] Money Order [ ] COD |
Card Number:
Expiration Date: |
| Signature: |
[ ] Ship what is in stock, back order the remainder.
[ ] Ship what is in stock, cancel the remainder.
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