Maryland Delivered Order Form |
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Complete this form and mail to:
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If paying by check or money order, make payable to: Maryland Delivered Or Fax This Form To: 410-840-8852
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Bill To: (Please Print Clearly) | Ship To: (if different than Bill To) |
Name: | Name: |
Address:
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Address:
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City,State,Zip: | City,State,Zip: |
Phone: | Phone: |
E-Mail Address: | E-Mail Address: |
Order Date |
Credit Card Number: Visa, MasterCard, American Express |
Expiration Date (M/Y) |
PLEASE SIGN HERE:
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Quantity | Item # | Description | Unit Price | Total |
Gift card sentiment or other instructions: | Subtotal | |||
Tax (6% MD)** | ||||
Shipping | ||||
Total Due |
Regular shipping charges: | ** Maryland Tax is charged on all items SHIPPED to a Maryland address |
Total
Cost of Items $0.00 - $15.00 $15.01 - $30.00 $30.01 - $45.00 $45.01 - $60.00 $60.01 - $75.00 $75.01 - $100.00 $100.01 - $150.00 $150.01 - $200.00 $200.01 - $300.00 $300.01 - $400.00 $400.01 and up |
Shipping
Rate $5.95 $7.95 $8.95 $9.95 $10.95 $12.95 $14.95 $16.95 $19.95 $22.95 $24.95 |
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