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 10.00 % of Total)

 

under 1 lb. - $6.50
1-2 lb. - $10.20
2-3 lb. - $11.50
3-4 lb. - $12.00
4-5 lb. - $12.50
5-6 lb. - $13.00

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 Golly Gear
7243 St. Louis Ave.
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