Please print out the form below, and VERY
NEATLY and LEGIBLY fill in ALL the information requested.
Make checks and money orders payable
to:
C.S.A. Worldwide and Mail to: C.S.A., PMB 1137, 1015 Gayley Ave., Los Angeles,
CA 90024
SHIPPING INFORMATION How did you hear about us? _________________ |
|||
|---|---|---|---|
Name/Company |
_________________________________ | Date |
____/____/____ |
Street Address |
_________________________________ | ||
City/State |
_________________________________ | Zip Code |
_____________ |
Day Phone |
(_______)________________________ | Evening Phone |
(_______)___________________ |
Fax # |
(_______)________________________ | ___________________________ | |
| ORDER INFORMATION | ||||
|---|---|---|---|---|
ITEM NUMBER |
DESCRIPTION |
QUANTITY | PRICE EACH |
TOTAL PRICE |
| . | . | . | . | . |
| . | . | . | . | . |
| . | . | . | . | . |
| . | . | . | . | . |
| . | . | . | . | . |
| . | . | . | . | . |
MERCHANDISE TOTAL |
$ | |||
| SHIPPING CHARGES (DOMESTIC, U.S.A.) | 8% SALES TAX |
||
| IF MERCHANDISE TOTAL IS: | CA RESIDENTS ONLY |
______________ | |
| $00.00 - $29.99 | ADD $6.00 | ||
| $30.00 - $39.99 | ADD $7.00 | SHIPPING CHARGES |
|
| $40.00 - $57.99 | ADD $8.00 | USE CHART AT LEFT |
______________ |
| $58.00 - $99.00 | ADD $9.00 | ||
| $99.01 and Over | ADD $11.00 | ORDER TOTAL | $_____________ |
| BACK TO GIFTS | QUESTIONS? CALL 800-807-2566 | SECURITY INFO |