Mail Order Form

ORDER BLANK: River Oak Acres Lampwork Beads

You may print this order blank using the "Print" Command on your browser (usually found under "File"). If ordering by Postal Mail, fill in the order blank and mail to: River Oak Acres Lampwork Beads, 614 Windsor Avenue, Lawrenceville, Va 23868-1516.

Name_________________________________________________________

Address_______________Apt. No.

City______________________StateZip

Phone (_)______________________

Your E-Mail_____________________________ (If you want Connie to email you when your order is shipped)

Item No.	Description	Qty.	Price Each	Total














SUBTOTAL
TOTAL PRICE

SHIPPING & HANDLING (Minimum Charge of $3.30)
TOTAL AMOUNT DUE

Shipping & Handling Calculations: All orders are shipped insured.
$ 00.00 to $ 49.99 - $ 3.30
$ 50.00 to $ 99.99 - $ 5.30
$100.00 to $199.99 - $ 7.30
$200.00 to $300.00 - $ 9.30
$400.00 to $600.00 - $11.30

ORDER BLANK: River Oak Acres Lampwork Beads

Name_________________________________________________________

Address_______________________________Apt. No.________________

City__________________________________State______Zip__________

Phone (_________)______________________________

Your E-Mail_____________________________ (If you want Connie to email you when your order is shipped)

Shipping & Handling Calculations: All orders are shipped insured.

___ Enclosed is my check or money order made payable to David Rasner

Address_______________Apt. No.

City______________________StateZip

Phone (_)______________________