Name:_________________________________________
Address: __________________________________________________________
City: ______________________State: ____________Zip Code: ___________
Phone #: ________________________ Email Address (optional): _______________________
| Item # | Quantity | Item Description (size, color, etc.) | Price |
Subtotal:______________
Sales Tax (MI residents add 6%) :______________
Shipping Charges (see chart):______________
Total:_____________
| Merchandise Total | Priority Mail (3-5 business days) |
| Up to $25.00 | $6.50 |
| $25.01 - 50.00 | $7.75 |
| $50.01 - 100.00 | $8.50 |
| $100.01 - 125.00 | $10.95 |
| Over $125.00 | $15.00 |