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Case Bonita Art Order Form
Item Code Item Title Quantity Item Price Line Total
 
Name: Merchandise total:   
Address: Less 20% (first time purchase only):   
             Security hardware @ $7.50 per item:   
  Phone:    
   Email: Shipping charge (see chart below):   
Shipping address (if different): CA residents (only) pay 7.75% sales tax:   
             Grand total:   
             Shipping and handling:  
Method of payment
Check Money Order American Express
Mastercard Discover VISA
Grand Total Shipping cost
Up to $99.00 $20.00
$100.00 to $199.00 $30.00
$200.00 to $299.00 $40.00
$300.00 to $399.00* $50.00
Each mirror $30.00
*Add $10.00 to shipping cost for every $100 additional purchase.

Credit card number:
- - -

Expiration date: /
Confirmation number:
Signature:



  Fill out, Print, and Fax this form to: 1-858-693-0453