CHECK OR MONEY ORDER PAYABLE TO:                                                                                                                           <BACK TO MAIN
SHANE, INC.
P.O. Box 1356 
Coventry, RI 02816
  Tel: 1(401) 822-4590   Fax: 1(401) 822-4860
 
IIA PURCHASE ORDER FORM
Expected Delivery:  2 - 4 Weeks after order received. PLEASE CALL FOR RUSH ORDERS
(type or print clearly)

COMPANY:
  __________________________________________
 
  SHIP VIA:  UPS [   ]    Parcel Post [   ]    Residential [   ]



NAME:
   _____________________________________________

 
 Order Is Needed By:
_____________________________



CHAPTER:
  __________________________________________

Shipping & Handling Rates:



ADDRESS:
___________________________________________

        $0.00  -  $49.99       S&H Rate $7.75




CITY, STATE:
 _________________________________________

        $50.00  -  $249        S&H Rate $10.75




ZIP:  ____________
    COUNTRY:  ______________________

        $250  -  and up>        S&H Rate $13.25




PHONE:
  ____________________________       EXT: __________


EMAIL:
  _____________________________________________

Residential Delivery Add $2.00 Extra
   International Orders will be advised
You will be advised if the delivery date cannot be met.

PLEASE LIST ITEMS TO ORDER BELOW:





ITEM #QUANTITYUNIT PRICEENGRAVINGFax or Mail This Order Form To:

________

______

$__________

$__________

1.401.822.4860


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______


$__________


$__________

PO Box 1356 . Coventry . RI . 02816

________

______

$__________

$__________
Orders must be followed up
with a check or money order.
No credit cards accepted.
______________$__________$__________


________

______

$__________

$__________
CHECK OR MONEY ORDER PAYABLE TO:  SHANE INC


________

______

$__________

$__________
IIA Logo


________

______

$__________

$__________


________

______

$__________

$__________


________

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$__________

$__________


________

______

$__________

$__________
(Engraving 13¢ per character)

Add the Total Unit Price with the
Total Engraving and S&H Rate to
Calculate Grand Total >>>>>>>>


TOTAL_
_______

TOTAL
________


S&H:
___________
Use Page 2 for
Engraving Information Only

GRAND TOTAL =

$______________
           






SHANE, INC.
P.O. Box 1356  
Coventry, RI 02816
  Tel: 1(401) 822-4590       Fax: 1(401) 822-4860
IIA ENGRAVING FORM
Use This Form For Specifying Engraving Information

Engraving Charge:  .13¢ per character  (punctuation and spaces not included)




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ITEM # _________     Please Type or Print Clearly                      

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ITEM # _________     Please Type or Print Clearly                      

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ITEM # _________     Please Type or Print Clearly                      

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