|
P
U R C H A S E .. O R D E R ..
F O R M .. F O R ..
P R O D U C T S .. A N D .. B O O K S |
||||
| Simply print out this order form and mail it in with your full payment. | ||||
|
Item
Description
|
How
Many
|
Price
|
||
|
Please check the following method of payment: ( No cash or C.O.D.s) Full payment enclosed - check or money order payable to : or Charge total amount to my : (check one)
|
Sandra Senzon's Tooth Spa 405 Lexington Ave. Tower
Suite 6900 |
TOTAL MERCHANDISE | $ | |
| Add shipping & Handling (see chart) | $ | |||
| UPS 4 day delivery | $ | |||
| NY residents add State/Local tax ($8.25) | $ | |||
| TOTAL AMOUNT DUE | $ | |||
|
Shipping
& Handling Merchandise total
|
||||
| VISA |
Up
to $20.00
|
$
4.95
|
||
| MASTERCARD |
$20.01
- $40.00
|
$
6.95
|
||
| Credit card account number : |
$40.01
- $60.00
|
$
7.95
|
||
| Expiration date : |
$60.01
- $90.01
|
$
8.95
|
||
| Daytime phone : |
$90.01
- $120.00
|
$
9.95
|
||
| Signature : |
$120.01
- $150.00
|
$
10.95
|
||
|
$150.01
& Over
|
$
11.95
|
|||