| 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. |
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| CREDIT CARD NUMBER | |||||||||||||||
| Month: | Year: | ||||||||||||||
| Expiration Date | Security Code | ||||||||||||||
| CARDHOLDER'S SIGNATURE | DATE SIGNED | ||||||||||||||