Shane Inc - IIA Mail and Fax Order Form

CHECK OR MONEY ORDER PAYABLE TO: <BACK TO MAIN
SHANE, INC. P.O. Box 1356 Coventry, RI 02816 Tel: 1(401) 822-4590
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 #	QUANTITY	UNIT PRICE	ENGRAVING	Send This Order Form To:
________	______	$__________	$__________
________	______	$__________	$__________		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
________	______	$__________	$__________
________	______	$__________	$__________
________	______	$__________	$__________
________	______	$__________	$__________
________	______	$__________	$__________
(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 =	$______________	Use Page 2 for Engraving Information Only

SHANE, INC.
P.O. Box 1356 Coventry, RI 02816
Tel: 1(401) 822-4590

IIA ENGRAVING FORM
Use This Form For Specifying Engraving Information

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


ITEM # _________ Please Type or Print Clearly Line 1: __________________________________________ Line 2: __________________________________________ Line 3: __________________________________________ Line 4: __________________________________________ Line 5: __________________________________________		ITEM # _________ Please Type or Print Clearly Line 1: __________________________________________ Line 2: __________________________________________ Line 3: __________________________________________ Line 4: __________________________________________ Line 5: __________________________________________

ITEM # _________ Please Type or Print Clearly Line 1: __________________________________________ Line 2: __________________________________________ Line 3: __________________________________________ Line 4: __________________________________________ Line 5: __________________________________________		ITEM # _________ Please Type or Print Clearly Line 1: __________________________________________ Line 2: __________________________________________ Line 3: __________________________________________ Line 4: __________________________________________ Line 5: __________________________________________

ITEM # _________ Please Type or Print Clearly Line 1: __________________________________________ Line 2: __________________________________________ Line 3: __________________________________________ Line 4: __________________________________________ Line 5: __________________________________________		ITEM # _________ Please Type or Print Clearly Line 1: __________________________________________ Line 2: __________________________________________ Line 3: __________________________________________ Line 4: __________________________________________ Line 5: __________________________________________