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	$21.86	$39.75
	Visa		$25.01 to $50.00	$9.95	$12.44	$27.36	$49.75
	Master Card		$50.00 to $100.00	$15.45	$19.31	$42.49	$69.75
	Discover Card		$100.01 to $200.00	$25.95	$32.44	$71.36	$84.75
	American Express		OVER $200.00	$39.95	$49.94	$109.86	$129.75
* "International" S&H is for Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Isle of Man, Italy, Mexico, Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom. If you're unsure, please contact us before placing your order."World-Wide" is for the rest of the world.

CREDIT CARD NUMBER

Month:

Year:

Expiration Date

Security Code

CARDHOLDER'S SIGNATURE

DATE SIGNED