| Date_______________ |
| Name___________________________________________ |
| Ship to Address___________________________________ |
| City, State, Zip____________________________________ |
| Phone (in case we have questions about order)_________________ |
| e-mail address (optional)_________________________ |
| Item Description | Quantity | Size of Item | Color Choice (webbing color for screens) (Item color for Sleazy-ware) | Price Each | Total for Item |
| Merchandise Total | |||||
| Ohio Residents add 5.75% Tax | |||||
| Shipping Charges | |||||
| Total for Order | |||||
| Shipping and Handling Charges | Under $20.00 | $5.50 |
| $20.01 to $50.00 | $6.50 |
| $50.01 to $100.00 | $8.50 |
| $100.01 to $200.00 | $10.50 |
| $200.01 to $300.00 | $13.50 |
| Over $300.00 | $16.50 |
| Shipments are via UPS Ground or US Mail | |
