ORDER REQUEST FORM
Name:____________________________________________________________
Email: __________________________________________
Phone: __________________________________________
Shipping Address: ____________________________________________________
_________________________________________________________________
Where did you hear about us? _________________________________________
ITEMS
| Item # |
Item Name |
Size |
Color |
Qty |
Price Ea |
Total |
| _____ |
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| _____ |
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| _____ |
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| _____ |
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| _____ |
____________________ |
____ |
_____ |
_________ |
___________ |
______ |
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ITEM TOTAL |
______ |
| |
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|
Shipping |
______ |
| |
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|
AK, HI, PR |
Shipping |
+ 3.00 |
| |
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|
|
Express |
2 Day |
+ 8.99 |
|
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|
Express |
Overnight |
+ 14.99 |
| |
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SUBTOTAL |
______ |
| |
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AL, NC |
7% Tax |
______ |
| |
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AMT DUE |
______ |
PAYMENT ENCLOSED
____ Check or money order for $ ___________ USD. Please do not staple.
____ Bill my credit card:__________________________ exp date: ____ cvv: ___
Billing address (if different from above)
______________________________________________
I authorize 365 Inc. to process payment as described above for my order. If shipping outside the United States, I agree to pay customs fees as required by my local government.
Signature (required) _____________________________________ Date ________
Check and Credit Card Orders Payable to 365 Inc.: Mail orders to "Mail Order, 431 Us Hwy 70-A East, Hillsborough, NC 27278-9334"
Credit Card Orders Only: Fax order to 1-800-950-1994.
United States Shipping Costs
| Order Total |
Standard Ground |
Two Day Air |
Next Day Afternoon |
| $0-$10 |
$4.99 |
$13.98 |
$19.98 |
| $10-$25 |
$5.99 |
$14.98 |
$20.98 |
| $25-$50 |
$7.99 |
$16.98 |
$22.98 |
| $50-$100 |
$8.99 |
$17.98 |
$23.98 |
| $100-$150 |
$9.99 |
$18.98 |
$24.98 |
| $150-$200 |
$10.99 |
$19.98 |
$25.98 |
| $200-$250 |
$11.99 |
$20.98 |
$26.98 |
| Over $250 |
By Weight |
By Weight |
By Weight |
International Shipping Costs
Please select International Shipping if shipping outside the United States. In addition to the shipping costs estimated below, the recipient is responsible for all customs fees icluding duties, taxes, brokerage fees, and any other fees assessed at the border before delivery.
International Shipping Zones
Zone 1: Canada
Zone 2: Europe, Australia, New Zealand, Japan, Caribbean, and Bermuda
Zone 3: Central America, South America, Hong Kong, Singapore, Taiwan, and all other countries
|
Zone 1 |
Zone 2 |
Zone 3 |
| Order Total |
Canada |
Europe & Pacific |
Asia & All Others |
| $0-$150 |
$20.00 |
$35.00 |
$45.00 |
| $150-$300 |
$40.00 |
$55.00 |
$55.00 |
| $300-$450 |
$60.00 |
$75.00 |
$75.00 |
| $450-$600 |
$80.00 |
$95.00 |
$85.00 |
| $600-$750 |
$100.00 |
$125.00 |
$115.00 |
| $750-$1000 |
$120.00 |
$150.00 |
$125.00 |
| Over $1000 |
By Weight |
By Weight |
By Weight |
Copyright © 2006 [365 Incorporated]. All rights reserved.
Effective: September 1, 2006
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