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Kids
Patch
BLANK ORDER FORM
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Mail To: P.O. Box 152
Rescue, CA 95672-152
FAX: 1-800-401-4671 (24 hrs)
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PRINT THIS FORM TO USE FOR FAX OR MAIL ORDERS
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PRICE |
TOTAL |
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Shipping/Handling Calculation: U.S. - Add $4.00 for first
item and $1.00 for each addt'l item. Canada - Add $5.00 for first
item and $1.25 for each addt'l item.
(Add Sales Tax if shipping to address in California) |
| Order Amount |
______________ |
| Sales Tax (7.25% CA) |
______________ |
| Shipping/Handling |
______________ |
| Total Order Amount |
______________ |
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Billing Information
APO/FPO enter APO or FPO in the City Field
and use the following two letter code in the State Field:
AA for Armed Forces Americas; AE for Armed
Forces Europe, Middle East, Africa and Canada; AP for Armed Forces
Pacific.
| Name: |
Apt/Suite/Box #: |
Address:
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Street:
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| City: |
State/Prov: |
| ZIP/Postal Code: |
Country: |
| Phone: ( ) |
Fax: ( ) |
| E-Mail: |
Business Name: |
Shipping Information (If Different - Leave Blank if Same
as above)
| Name: |
Apt/Suite/Box # |
Address:
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Street:
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| City: |
State/Prov: |
| ZIP/Postal Code: |
Country: |
Check or Money Order - Make Payable to: Kids Patch
(Checks drawn on U.S. Banks, Checks/Money Orders in U.S.
Dollars)
Credit Card
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Credit Card Number
Expiration Date ____/____
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| Exact Name as on Card
_______________________________ |
Signature (Must be signed)
________________________________ |
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