ORDER FORM FOR MAIL IN ORDERS

Make Checks or Money Orders Payable to:
Mike DeFilippo
22858 Markham Way
Boca Raton Fl, 33428A
(954) 464-0174
Your Name  

Shiping Address

 

 
Home Phone  
Cell Phone  
Work Phone  

Additional Shipping Instructions

 

 
Please add s&h according to the rates noted. Thanks Purchase of $.01 to $9.99 ............... add $5.95 for s&h
Purchase of $10.00 to $49.99 ......... add $7.25 for s&h
Purchase of $50.00 to $99.99 ......... add $10.85 for s&h
Purchase of $100.00 to $199.99 ..... add $15.55 for s&h
Purchase of $200.00 Or More ....... add $20.86 for s&h

PRODUCT NAME & #
QUANTITY
INDIV. PRICE
TOTAL PRICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

       
       
       
       
       
       
   
SUBTOTAL
 
   
SHIPPING
 
   
TOTAL ORDER