| Order Form |
|
PO Box 419, Accord MA 02018-0419 USA |
| Phone: 781-982-8100 | ||
| Fax: 781-871-9989 |
| Order Form |
|
PO Box 419, Accord MA 02018-0419 USA |
| Phone: 781-982-8100 | ||
| Fax: 781-871-9989 |
Bill To / Ordered By (Please Print) |
Ship To (ONLY if different from "Ordered By") | ||
| Name: | |
Name: | |
| Address: | |
Address: | |
| City/State/Zip: | |
City/State/Zip: | |
| Day Phone: | |
Eve Phone: | |
| * E-mail: | |
* E-mail: | |
[ ]Visa [ ]MasterCard [ ]American Express [ ]Discover |
| Account Number: | Expires: | Security: | ||||||||||||||||||||||||||||||||||
|
Shipping & Packaging (US Only) |
|||
| Up to $39.99 | $8.95 | $100.00 to $149.99 | $21.50 |
| $40.00 to $59.99 | $12.50 | $150.00 & Over | $29.75 |
| $60.00 to $99.99 | $15.30 | ||
| Qty | Item # | Description | Unit Price | Total |
| Total $ | ||||
| Add 6.25% Sales Tax (Tax for MA Non-Food Items) | ||||
| Shipping & Packaging (See Chart Above) | ||||
| Total Order Amount | ||||
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