Golly Gear Order Form

       
 

Ordered by:


phone number

Ship to:


email
 
Quantity
Item Description
Size and Color
Price
       
   
Total Sales
   
Sales Tax (Illinois residents add 9.00 % of Total)
 

under 1 lb. - $6.25
1-2 lb. - $9.00
2-3 lb. - $9.50
3-4 lb. - $10.75
4-5 lb. - $12.00
5-6 lb. - $14.50

 6-7 lb. - $15.00
7-8 lb. - $16.00
8-9 lb. - $17.00
9-10 lb. $18.00
over 10 lb. $25.00
Shipping
   
Total
  If paying by check, please make payable to
Second Editions 		   
  If you wish to pay by credit card, please indicate:

number (Visa, Master Card, Discover, American Express)

expiration date

Please mail this form to GollyGear
4104 Oakton St.
Skokie, IL 60076

If you have any questions, please call 800-694-6531.

Thank you.

 
 
verirfication code (last 3 digits on back of card in signature space)

 

signature