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ORDER
FORM |
Date: _______________________________________
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Shipping
Information |
Billing Information
(if different from Shipping) |
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Name:_______________________________________ |
Name:_______________________________________ |
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Address:_____________________________________ |
Address:_____________________________________ |
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City:________________________________________ |
City:________________________________________ |
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State:_________ Zipcode:______________________ |
State:_________ Zipcode:______________________ |
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Phone
Number:_______________________________ |
Phone
Number:_______________________________ |
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email:_______________________________________ |
email:_______________________________________ |
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Credit Card Information |
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Credit Card Type: VISA MasterCard American Express Discover |
Number:_____________________________________ |
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Signature:____________________________________ |
Expiration_Date:_____________ CSC Code: _______ |
Your
signature is authorizing Ladybug Gift Store to charge your credit card for this
order
Order:
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Item Number |
Description |
Gift Wrap1 |
Qty |
Unit
Price |
Total
Price |
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Gift
Wrap Charges1 |
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Sub-total |
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Shipping
& Handling2 |
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Gift Message: |
______________________________ |
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Sub-total |
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______________________________ |
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Tax3 |
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______________________________ |
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Total |
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Notes:
1
Gift Wrap Preference: No Gift Wrap,
Complimentary White Gift Paper or Box with Ribbon, or Premium Gift Wrap at $3.49 for each
item.
2Shipping
and Handling Charges for shipping within the continental U.S. as well as Alaska, Hawaii, Puerto Rico, Guam and Military Stationed Overseas:
|
Merchandize Total |
Standard Delivery |
3 Day Air Delivery |
Merchandize Total |
Standard Delivery |
3 Day Air Delivery |
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$00.01 to $20.00 |
$5.95 |
$9.95 |
$80.01 to $100.00 |
$12.95 |
$16.95 |
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$20.01 to $40.00 |
$8.95 |
$12.95 |
$100.01 to $200.00 |
$14.95 |
$18.95 |
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$40.01 to $80.00 |
$9.95 |
$13.95 |
Over $200.00 |
$16.95 |
$20.95 |
3If the
shipping destination is
Print the form. After
completing all entries, mail the order form to the address at the
top of the page. You will receive email confirmation when we receive your order.
Thank you for your order!