Phone: 785-539-1996 E-mail: griese@scicablecom.com
Instructions: Use this order form for e-mail and mail orders. We accept Visa and Mastercard credit cards, personal checks or money orders for e-mail and mail orders. Be sure to include the shipping or handling fee if it applies to your purchase. If you are in Kansas, be sure to add 6.3% sales tax. If the proper payment is not enclosed, this will delay your shipment until payment is received. To expedite your mail order, please e-mail our company at griese@scicablecom.com to let us know you are sending payment by mail so that we can set aside your purchase and prepare your shipment for you. Mail this order form with payment to:Customer information (Please type or print legibly.)
Your Name:__________________________________________________________________________________________________
Billing Address:_______________________________________________________________________________________________
Shipping Address (if different than your Billing address): ________________________________________________________________
Shipping to a Home or Business Address? (circle one)
Home Phone:__________________________ Work or Cell phone:____________________
E-Mail Address:______________________
Payment Method:
( ) Check or Money Order (Make your check or money order payable to me, Maurenne Griese, RN.)
( ) Credit Card Type ( )Visa ( ) Mastercard Credit Card Number: _________________________________________ Exp Date_____
Order Information
Quantity
Item Description Price Total
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Subtotal: __________
Kansas Residents add 5.3% sales tax: __________
Shipping and Handling: __________
Total Amount Enclosed: __________
Shipping and Handling Fees
| Purchase Total | Shipping and Handling |
| $0.01 USD - $9.99 USD | $3.00 USD |
| $10.00 USD - $49.99 USD | $7.00 USD |
| $50.00 USD - $99.99 USD | $10.00 USD |
| $100.00 USD - $199.99 USD | Free |
| $200.00 USD and up | Free |