Rush me the items listed below.
Print form and complete. Mail along with check or money order (no cash please) to:
Frank L. Jerry
541 N. Quaker Lane
Hyde Park, NY 12538
Name
Address
City
State
Phone
Zipcode
E-mail
Quantity
Item #
Name of Item
Unit Price
Total
Use more than one form if needed
Subtotal:
If your sub-total is:
USA Only
under
$
10.00
add
$ 4.70
$10.00
to
$49.99
add
$ 6.20
$
50.00
to
$
99.99
add
$ 8.95
$100.00
to
$199.99
add
$13.95
$200.00
and
over
add
$15.95
Shipping Fees
New York Residents please add sales tax (8.125%)
Total
:
Check
(made payable to Frank L. Jerry)
Money Order
Thank You for your Order!
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