MAIL & FAX ORDER FORM [Please print this out to use]
Celtic Myth & Moonlight, 641 Penn Avenue, West Reading, PA 19611
Phone: (610) 685-2307	Fax: (610) 685-2308
Email: celticmythmoon@aol.com	Website: www.celticmythmoon.com

ORDERED BY		SHIP TO (IF DIFFERENT)
NAME:		NAME:
BILLING/MAILING ADDRESS:		SHIPPING ADDRESS:
CITY:		CITY:
STATE/PROVINCE:		STATE/PROVINCE:
ZIP/MAILING CODE:		ZIP/MAILING ADDRESS:
COUNTRY:		COUNTRY:
EMAIL ADDRESS:		TELEPHONE #:

QUANTITY	BRIEF DESCRIPTION	SIZE	COLOR	PRICE EACH	TOTAL COST
May we add you to our email list to receive our monthly newsletter? YES ____ / NO ____		SUB-TOTAL:
NOTE: Any coupons MUST be included with your order:		LESS ANY DISCOUNT:
Sales within Pennsylvania are taxable, except for herbs, clothing or food items:		6% SALES TAX [PA ONLY]:
NOT ALL MERCHANDISE SHOWN ON OUR WEBSITE WILL ALWAYS BE IN STOCK. IF WE'RE OUT OF AN ITEM YOU'VE ORDERED WE'LL EMAIL YOU.		SHIPPING & HANDLING :
		TOTAL:

METHOD OF PAYMENT			STANDARD SHIPPING AND HANDLING COSTS (U.S. DOLLARS)
	Personal Check		ORDER TOTALS	U.S.A.	CANADA	INTERNATIONAL*	WORLD-WIDE**
	Money Order		$0.01 to $25.00	$7.95	$9.94	$25.84	$39.75
	Visa		$25.01 to $50.00	$9.95	$12.44	$32.34	$49.75
	Master Card		$50.00 to $150.00	$15.45	$19.31	$50.21	$77.25
	Discover Card		$150.01 to $300.00	$25.95	$32.44	$84.34	$129.75
	American Express		OVER $300.00	$39.95	$49.94	$129.84	$199.75
* International S&H is for Canada, Mexico and western Europe. If you're unsure, please contact us before placing your order. ** Shipping Rates for the rest of the world.

CREDIT CARD NUMBER

Month:

Year:

Expiration Date

Security Code

CARDHOLDER'S SIGNATURE

DATE SIGNED