Order
Form
Quantum
Specialities
716 W. McClellan
St.
Lead, SD 57754
(605) 722-3325
E-Mail: quantum@rushmore.com
Print out order form and Mail it to me at the address above.
| ORDER FROM: | |
| Name: | ___________________________________________________________ |
| Address: | ___________________________________________________________ |
| City: | ______________________ State: ________ Zip Code: ______________ | ||||
| Phone #: | (______)______-____________________ Ext: _____________________ | ||||
| SHIP TO: (If different than order information) | |
| Name: | ___________________________________________________________ |
| Address: | ___________________________________________________________ |
| City: | ____________________ State: ________ Zip Code: ________________ | ||||
| Product
# |
Qty. |
Color |
Description |
Price
Each |
Total
Price |
||
| Total Merchandise | ||
| Normal Shipping | ||
| Special Shipping - Please Call | ||
| SD Sales Tax 6% | ||
| Total |
| Total Price of Items | Normal Shipping Amt. |
| $0 - 25.00 | $3.95 |
| $25.01- 50.00 | $5.95 |
| $50.01 - 100.00 | $7.95 |
| $100.01 - 150.00 | $9.95 |
| $150.00+ | $11.95 |
| For shipments outside the 48 contiguous states of the USA, please call or e-mail for shipping fees. | |
|
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