ORDER FORM
Name: Membership #Address:
City: State: ZIP: Phone #:
Email:
Item #
QTY
Description
Color/Size
Price
Total Amt.
Subtotal
Sales Tax 8.3% (For California Residents Only)
Packing & Shipping Up to $14.99 Add $4.05 15.00 - 19.99 Add $4.35 20.00 - 24.99 Add $4.65 25.00 - 29.99 Add $5.45 30.00 - 34.99 Add $6.05 35.00 - 39.99 Add $7.00 40.00 - 44.99 Add $7.80 45.00 - 49.99 Add $8.60 OVER $50.00 Add $9.25
Order Total
Payment Options Money Order Personal Check Certified Check
(Please note: Personal checks take 2 weeks to verify)
Please allow 2 to 3 weeks for delivery.
PLEASE PRINT CLEARLY AND SEND TO:
Locey's Gift World
C/O Richard Vazquez
P.O. Box 10788 PMB 164
Ponce, P.R. 00732