This is the
"Fill it out, print It and mail It to us" Order
Form
If you choose
to print it out then fill it in, please print clearly – we hire idiots.
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Name:
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Address:
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City,
State, Zip:
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Phone:
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E-mail:
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| How did you hear about us? | |
| Do you eat between midnight and 3 am? | Yes No Not that I remember... |
| Have you ever swallowed a bug while riding your bike? | Yes No I have an exercise bike |
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QUANTITY |
ITEM # |
DESCRIPTION |
PRICE EACH |
TOTAL AMOUNT |
| 200000 | Cooking without a Conscience |
$10.95 |
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| 200100 | Old Brown Shoe Seasoning |
$5.50 |
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| 200101 | Danger Men Cooking Tape |
$4.50 |
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| 200102 | Beer Holster |
$15.00 |
TOTAL
| Merchandise Total | |
| Shipping & Handling | |
| Sales tax (MD residents only) 5% | |
| TOTAL ORDER AMOUNT |
SHIPPING & HANDLING CHART
| For Merchandise Total |
add
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| $0.00 to $ 12.00 |
$5.25
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| $12.01 to $ 32.00 |
$6.60
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| $32.01 to $ 50.00 |
$7.95
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| $50.01 to $ 64.00 |
$9.30
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| $64.01 to $ 100.00 |
$10.65
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| $100.01 and up |
$12.00
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Make checks payable to:
Dueling
Impalas Productions, Inc.
c/o Cooking Without a Conscience P.O. Box 118 Sykesville, MD 21784
Please allow 5-10 business days for delivery. Thank you for ordering!