SHIPPING INFO
BILLING INFO (fill in only if different)
Name _________________________ Name __________________________ Ordering Methods
Address _________________________ Address __________________________ Home
_________________________ __________________________
Phone _________________________ Phone __________________________
Email _________________________ Email __________________________
CREDIT CARD INFO (if not paying by money order)
Card # ____________________ Exp. ____________________
Name on Card ____________________ Type Visa Mastercard Discover  (circle one)
SHIPPING RATES
Continental USA:
Merchandise Total:

$0.01   -$10.00
$10.01 -$25.00
$25.01 -$40.00
$40.01 -$75.00
$75.01-$100.00
$100.01-$200.00
$200.01 and over

Add:
$3.95
$6.25
$7.25
$7.95
$9.50
$15.00
FREE
For International Shipping & Handling
please see Ordering Methods.
PURCHASE INFO
Product Code
(if applicable)
Description Qty Price Ea. Amount
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
_____________ _______________________________ ____ $_______ $______
Subtotal $______
Shipping Method _______________________________ Shipping $______
GRAND TOTAL $______

Mail this completed form to:

POZSGAI'S DESIGNS,
19390 S.W. Murphy St.,
Aloha, OR 97007-4428

or call:

1-800-872-2803

or you can FAX it 24/7 to:

1-800-872-2803