My Custom Pens.com
Mail In Order Form
Date:___________________
First Name:_________________________________
Last Name:_________________________________
Shipping
Address: ___________________________________
(physical street address, Please)City and State:______________________________
Country: _____________________________
Postal - Zip Code:______________________
Home Phone:_____________________________
Other Phone:_____________________________
email: _____________________________
Fax
Number:____________________________
Payment Method:
Quantity
Item Number
(If Applicable)
Description of Item
Price Each
Price Total
____ ______________ ____________________________________ $__________ $__________
____ ______________ ____________________________________ __________ __________
____ ______________ ____________________________________ __________ __________
____ ______________ ____________________________________ __________ __________
____ ______________ ____________________________________ __________ __________
____ ______________ ____________________________________ __________ __________
____ ______________ ____________________________________ __________ __________
____ ______________ ____________________________________ __________ __________
____ ______________ ____________________________________ __________ __________
Product Sub-Total = __________-------------------------------------------------------------------
Page One Sub-Total = __________ Plus Shipping & Handling + __________ SUB-TOTAL = __________ Plus Sales Tax (8.25%) + __________ TOTAL AMOUNT DUE = __________(Include Sales Tax for Texas Residents Only -
Please include Shipping & Handling when figuring Sales Tax Amount)
Shipping and Handling:
$ 00.00 To $ 29.99 add $ 6.00
$ 30.00 To $ 49.99 add $ 7.50
$ 50.00 To $ 74.99 add $10.00
$ 75.00 To $ 99.99 add $12.50
$100.00 To $149.99 add $15.00
$150.00 To $199.99 add $17.50
$200.00 To $249.99 add $20.00
$250.00 To $299.99 add $22.50
$300.00 To $349.99 add $25.00
$350.00 To $399.99 add $27.50
* All Orders above $400.00 Please email or call for current rates
** All international orders outside the USA, Please add $10.00 to the above amounts. (Ivory items cannot be shipped outside the USA)
Please Mail Order and Payment To:
My Custom Pens.com
P. O. Box 461104
Garland, Texas 75046
*** REMEMBER - Email us with your items ordered information so we can place your items in a pending order status for you.
Thank You for your Trust in us
and your continued patronage!
and Have a Blessed Day!
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