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PRINT this form out, FILL it in, and then FAX, MAIL or PHONE in your order
| Name Date | |||||
| Address | |||||
| Phone Number | |||||
| Description | Qty | Size | Color | Unit Price | TOTAL |
| Shipping and Handling | Merchandise Total |
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| Up to $25.00 |
$7.25 |
Shipping and Handling | |||
| $25.00 - $49.99 |
$8.25 |
SUBTOTAL | |||
| $50.00 - $74.99 |
$9.75 |
MD Residents Add 5% Sales Tax | |||
| $75.00 - $99.99 |
$11.25 |
TOTAL ENCLOSED | |||
| $100.00 - $149.99 |
$12.75 |
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| $150.00 - $199.99 |
$15.00 |
Make Checks Payable To: COPSstore | |||
|
$200.00 - UP |
$19.75 |
Credit Card Orders May be Faxed to: (301) 253-1530 |
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Circle Payment Type: Check Enclosed VISA Mastercard |
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Credit Card Number: Expiration: |
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| I agree
to pay the above total amount according to the card issuer agreement. Signature: |
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