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Print form and mail to:
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Hiller Productions
W7038 Farmers Grove Road
Monticello WI 53570 |
Name:
________________________________________________
Address:
______________________________________________
City,State, Zip:
__________________________________________
Phone #:
_______________________________________________
Email:
_________________________________________________
If you need more space, use back of form or another
sheet of paper.
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Quantity |
Item # |
Production Title/Description |
Price Each |
Total |
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Merchandise Total __________
Sales Tax 5.5% (only if you live in
Wisconsin) __________
Sub-Total __________
Add Postage and Handling Charges from
the chart below __________
TOTAL ENCLOSED __________
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PAYMENT METHOD: Payment must be made in US
Funds.
____ Check ____ Money Order
____ MasterCard ____ VISA ____
American Express ____ Discover
Credit Card Number:
_____________________________________
Expiration Date (MM/YY):
________________________________
Name on Card
___________________________________________
Thank you!
SHIPPING & HANDLING CHARGES:
| ORDER TOTAL |
USA |
CANADA |
OTHER |
| Up to $30.00 |
$ 7.00 |
$14.00 |
$16.00 |
| $30.01 to $75.00 |
$ 9.00 |
$16.00 |
$18.00 |
| $75.01 to $100.00 |
$11.00 |
$18.00 |
$30.00 |
| $100.01 to $150.00 |
$14.00 |
$30.00 |
$47.00 |
| Over $150.01 |
$20.00 |
$38.00 |
$60.00 |
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