| Mouse Pad Order Form
Price per mouse pad: $9.95 each
Postage and Handling: $4.00 per pad ordered
E-MAIL AN ORDER: simply send the order information to us by email to bracken@brackenhouse.com.
FAX AN ORDER: Fill out this form and fax to: 1-435-674-5168.
PHONE AN ORDER: Call toll-free 1-800-295-5217, from 10 a.m. until 6 p.m. Mountain Time.
MAIL AN ORDER: Print out this order form and send to:
Bracken House, Inc.
70 West 700 South
St. George, Utah 84770 USA |
Payment must accompany order and must be in United States funds.
Make Checks payable to Bracken House, Inc.
ADD $4.00 PER PAD ORDERED SHIPPING & HANDLING: |
| ITEM # |
QUANTITY ORDERED |
PRICE PER UNIT |
AMOUNT |
| . | . | @ $9.95 | $ |
| . | . | @ $9.95 | $ |
| . | . | @ $9.95 | $ |
| . | . | @ $9.95 | $ |
| . | . | @ $9.95 | $ |
| SUB-TOTAL | $ |
| ADD $4.00 PER PAD ORDERED SHIPPING & HANDLING | $ |
| ORDER TOTAL | $ |
| SHIPPING INFORMATION: Complete the following form. Please print clearly. |
| FIRST NAME: | . |
| LAST NAME: | . |
| SHIPPING ADDRESS: | . |
| EMAIL ADDRESS: | . | PHONE: | . |
| CITY: | . | STATE: | . |
| ZIP: | . | COUNTRY: | . |
| PAYMENT METHOD: CIRCLE ONE. |
VISA OR
MASTER CARD | DISCOVER |
AMERICAN EXPRESS | CHECK OR MONEY ORDER |
| CREDIT CARD NUMBER: | . |
| EXPIRATION DATE: | . |
| YOUR SIGNATURE: | . |
| MAIL TO: |
Bracken House, Inc.
70 W. 700 S.
St. George, Utah 84770
U.S.A.
PHONE: 800-295-5217
FAX: 295-674-5168
EMAIL: bracken@brackenhouse.com
LOCATED AT: www.brackenhouse.com |
