Queen of the Holy Rosary Mediatrix of Peace Shrine

ORDER FORM
 

PLEASE PRINT LEGIBLY:                                                                                 DATE: ________________________

 

NAME: ___________________________________
 

ADDRESS: _______________________________

 

CITY: ___________________  STATE:___________  ZIP: ____________

 

COUNTRY: ________________________

 

PHONE: ___________________________  E-MAIL: ____________________

 

ITEM NUMBER

DESCRIPTION

COLOR/ SIZE

QTY

PRICE PER EACH ITEM

TOTAL PRICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Text Box: U.S.Shipping & Handling: Free materials   add $2.00 Up to $5.00       add $2.00 Up to $9.50       add $3.50 Up to $15.00      add $4.50 Up to $20.00      add $5.50 Up to $25.00      add $6.50 For larger orders, please call for charges

Subtotal

 
 

 

 

Text Box: Canadian Shipping & Handling: Canadian currency Free materials  add  $4.00 Up to $3.00     add  $4.00 Up to $10.00   add  $15.00   UNPAID ORDERS WILL BE SHIPPED C.O.D. Credit Cards are not accepted.        

Shipping
 

 

 

 

WI residents only – add 5.5% sales tax

 

 

Total Amount Due