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Print this page
- Call (603) 668-5900, Fax to: (603) 669-5921,
or mail to: Cookie Art Exchange, PO Box 4267, Manchester, NH 03108-4267
See Ordering
Information for additional information.
| Ordered
By: |
Shipping/Gift
Address (Circle
One/Only if different
from Ordered By)
|
| Name:___________________________________________ |
Name:_________________________________________
|
| Address:_________________________________________ |
Address________________________________________
|
| City:____________________________________________ |
City:___________________________________________
|
| State:___________
Zip Code:_______________________ |
State:________
Zip Code:_________________________
|
| Daytime
Phone:___________________________________ |
Gift
Card Message:_______________________________
|
| Evening
Phone:___________________________________ |
_________________________________________________
|
| e-mail
address:___________________________________ |
|
| QTY. |
ITEM
#
|
DESCRIPTION
|
ITEM
PRICE
|
TOTAL
|
|
_____
|
_______
|
_______________________________________
|
_________
|
_________
|
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|
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|
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|
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|
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_______________________________________
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_______________________________________
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_______________________________________
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_______________________________________
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_________
|
_________
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>
If more room is needed,
include a blank piece of paper
<
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Shipping
& Handling
to each address
Up to $
25 - $ 6.99
$25.01
- $ 35 - $ 9.99
$35.01
- $ 55 - $10.99
$55.01
- $ 75 - $12.99
$75.01
- $100 - $14.99
$100.01
- $150 - $17.99
$150.01
- $200 - $25.00
$200.01
- $300 - call for pricing
|
Your
Total
Shipping
& Handling
|
__________
__________ |
| EXPRESS
DELIVERY: |
|
| 3
Days - Add $12.00
to standard shipping rate |
__________ |
| 2
Days - Add $18.00
to standard shipping rate |
__________ |
CANADA
Calculated at
time of order
Alaska
& Hawaii, APO/FPO
Calculated at
time of order
|
__________
__________
|
|
|
| Total
Your Order |
__________ |
| Total
Gift Order |
__________ |
| GRAND
TOTAL |
__________ |
|
Method of Payment:
Check #_______ Money Order _______ Payable to:
Cookie Art Exchange |
|
($20.00
Returned Check Fee)
|
| MasterCard
#__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date__ __/__ __ * |
| VISA # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
__ Expiration Date__ __/__ __ * |
*
3-DIGIT non-embossed number printed on the signature panel on
the back of the card:________
Signature:______________________________________________________________________
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