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Print form and mail to:    

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.

Quantity

Item #

Production Title/Description

Price Each

Total

         
         
         
         
         
         
         
         
         
         
 


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 __________   

 

PAYMENT METHOD:  Payment must be made in US Funds.

____ Check    ____ Money Order    

____ MasterCard    ____ VISA   ____ American Express    ____ Discover

Credit Card Number:  _____________________________________

Expiration Date (MM/YY):  ________________________________

                                                                                                Thank you!

SHIPPING & HANDLING CHARGES:

TOTAL ORDER USA CANADA FOREIGN COUNTRIES
Up to $11.99 $ 5.00 $ 6.00 $13.00
$12.00 to $44.99 $ 7.00 $11.00 $15.00
$45.00 to $69.99 $ 9.00 $13.00 $17.00
$70.00 to $99.99 $11.00 $15.00 $19.00
Over $100.00 $12.00 $16.00 $20.00

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