| To obtain a copy of this form: Click on File (upper left hand corner of your screen), click on Print , then select OK. |
| THE SCARLET LETTER P.O. BOX 397 SULLIVAN, WI 53178 |
PHONE: 262-593-8470 M - F: 10 AM -4 PM | |||
| e-mail: samplers@scarlet-letter.com | ||||
| WEBSITE: http://www.scarlet-letter.com | ||||
| ORDERED BY: _____________________________ | |
| ADDRESS: ________________________________ | |
| CITY/STATE/ZIP: ______________________________________ | |
| DAYTIME PHONE: _____ - ______ - ______________ | |
| SHIP TO: _______________________________ | |
| ____________________________________________________ | |
| Catalogues $10.00 if ordered separately. Would you like a catalogue? 1 Yes 1 No |
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| Quantity | Name of Item* | Shipping Code | Price |
|---|---|---|---|
| CREDIT CARD PAYMENT: |
ITEM TOTAL
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| ( Minimum Credit Card Order is $15.00) |
POSTAGE & HANDLING
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| 1VISA 1AMERICAN EXPRESS |
SUBTOTAL
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| 1MASTERCARD 1 DISCOVER |
WI Residents Add 5%Sales Tax
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| EXPIRATION DATE: ___ -___ |
GRAND TOTAL
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| Make sure to give us all 13 or 16 digits and the card's expiration date. | |||||||||||||||