Country Morning
Order Form
| To Place Order
Call: (703) 494-6983 Hours of Operation: Monday - Friday 10:00 a.m. - 5:00 p.m. Saturday - 10:00 a.m. - 6:00 p.m. Sunday - 11:00 a.m. - 5:00 p.m. |
Or Fax
This Sheet To: (703) 492-4883 Fax Your Order |
All Orders Are Processed Within 5 - 10 Business Days.
Your Name: |
Quantity |
Item # |
Item Name |
Weight | Price Each |
Total |
Total Weight |
__________ | ||||
Sub Total |
______________ | ||||
x.045% Sales Tax |
______________ | ||||
Sub Total |
______________ | ||||
Shipping Charges |
______________ | ||||
Grand Total |
______________ | ||||
Section II
Please Print Clearly.
Your Name: |
||
Shipping Address: |
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State: |
Zip Code: | |
Phone Number: |
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E-Mail Address: |
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Payment Method-circle |
Visa ( ) Mastercard ( ) American Express ( ) Discover ( ) Check ( ) M/O ( ) | |
Credit Card Number: |
Exp. Date: | |
Shipping Charge Scale:
Weight (in pounds)
| Over | Less | Charge |
| 0 | 2 | $4.00 |
| 2 | 4 | $4.75 |
| 4 | 7 | $9.00 |
| 7 | 10 | $10.50 |
| 10 | 14 | $13.00 |
| 14 | 20 | $15.00 |
| 20 | 25 | $17.00 |
| 25 | 30 | $20.00 |
| 30 | 35 | $23.00 |
| 35 | 40 | $25.00 |
| 40 | 45 | $28.00 |
| 45 | 50 | $31.00 |
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