Specialties & Gifts Order Form

NAME:

Date:

QTY:ITEM NO:DESCRIPTION:PRICE:TOTAl:
QTY:ITEM NO:DISCRIPTION:PRICE:TOTAl:
QTY:ITEM NO:DISCRIPTION:PRICE:TOTAl:
QTY:ITEM NO:DISCRIPTION:PRICE:TOTAl:
QTY:ITEM NO:DISCRIPTION:PRICE:TOTAl:
QTY:ITEM NO:DISCRIPTION:PRICE:TOTAl:
QTY:ITEM NO:DISCRIPTION:PRICE:TOTAl:

Sub Total:
Note: Hawaii Residents Sale Tax (Multiply sub total by .4166)
Add:(If Applicable) Sale tax:
(Multiply sub total by 12%) Shipping & Handling:
Please Note:
For Alaska, Puerto Rico, Vigin Island, Guam Canada and Hawaii orders. Multiply sub total by 20% charge.
For International orders. Multiply sub total by 25%.

(Add: Sub Total + Shipping & Handling ) Amount to remit to Specialities and Gifts Emporium

Shipped to:

Address:

City:

State or Country:

Zip Code:

Telephone(Area code first):

Email address:

referred by or referral number (If Applicable):

Comments:

Before you submit your order. Please print for your record.