Mail Order Form
Bill To:
Name
Address
City,ST,Zip
Day Phone
E-mail
Ship To:
(if different from billing address)
Name
Address
City,ST,Zip
Qty
Item#.
Name
Price
Total
Sub Total
New York State Residents Please Add 8.25% Sales Tax
Shipping and Handling
Total
Method of Payment:
(circle one)
Check
Discover
Money Order
Visa
American Express
MasterCard
Card No
Expiration
Cardholder's Signature
Print this form, fill in your address and payment information, and send the completed form to us by:
Telephone:
(800) 499-6751
Mail:
Priceless Corp
850 Howard Ave. - 4C
Staten Island, NY 10301
Please make Check/Money Order payable to
Priceless Corp.