Print Order Form
TO PLACE AN ORDER - PRINT THIS PAGE AND FAX IT TO (509) 352-1615 OR MAIL TO: P.O. Box 650124 Potomac Falls, VA 20165-0124 U.S.A.

ORDER INFORMATION: Please fill out the form below as completely as possible.

Ordered By:
 Name: ________________________________________________
 Address: ______________________________________________
 City: __________________________________________________
 State/Zip:______________________________________________
 Phone #: ______________________________________________
 Email: _________________________________________________

Ship To:
 Name: ________________________________________________
 Address: ______________________________________________
 City: __________________________________________________
 State/Zip:______________________________________________
 Country:_______________________________________________
 Phone #:_______________________________________________

QTY.

ITEM

DESCRIPTION

PRICE

AMOUNT
         
   

 

   
         
         
         
         
         
         

 Subtotal

 

 Shipping and Handling

 

 Grand Total

 
(All prices include applicable taxes , Resident's of VIrginia please add .06% to total)

Method of Payment:
 
_____
_____
_____
_____
_____ - Check or Money Order
M.C.
Visa
A.E.
D.C.
Make checks payable to: PoliticalGifts
Note: Items cannot be shipped until check clears bank.
 Credit Card # - __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
 Name as it appears on card: ___________________________
 Signature: ______________________ Exp. Date: ___/___


SHIPPING & HANDLING-  

Shipping and handling charges for each US address: Bumper Stickers - no charge. For multiple items follow chart below. Add an additional $10 if outside the Continental U.S.

2.50 to 6.99 -- $2.95
7.00 to 9.99 -- $3.95
10.00 to 24.99 -- $4.95
25.00 to 49.99 -- $5.95
50.00 to 99.99 -- $6.95

 100.00 to 199.99 -- $7.95
200.00 to 299.99 -- $8.95
300.00 to 399.99 -- $9.95
400.00 to 499.99 -- $10.95
500.00+ -- FREE

If you require additional space for your order, attach an extra page to this form.