Your Shipping Address:
Name _____________________________________________________
Address _____________________________________________________
Address _____________________________________________________
City ______________________________ State ______________
Zip Code _____________________ Country ____________________
Telephone _______________________________ (optional, helpful)
E-mail _______________________________ (optional, helpful)
| DESCRIPTION |
ITEM CODE |
-SIZE- |
-QUANTITY- |
-ITEM-PRICE |
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| SUB-TOTAL > ________ |
| NY Residents add sales tax of 8.75% > ________ |
| Shipping & Handling $5.00 (per 1 to 2 items) for all
orders under $85.00 TOTAL > ________ |
| Shipping & Handling $1.50 (per item) for all orders
over $85.00 TOTAL > ________ |
| - Please make all checks or money orders payable to: The Misfit (Cult)ure - |
| All items purchased, with checks and money orders, please allow
3 to 5 weeks for delivery. |
Thank you for your order!