| PriorService.com Printable Order Form
|
P.O. Box 27029 Baltimore, MD 21230 Phone: (410) 528-1192 Fax: (410) 510-1629 To Order Toll Free 1-877-241-8611 Hours: 10:00 am to 5:00 pm Eastern Time Monday - Friday |
| Name: |
| Street Address: |
| City, State & Zip: |
| Telephone Number: |
| Email address: |
| Payment Type: Check Money Order VISA MasterCard Discover American Express |
| Credit Card #: |
| Expiration Date: |
Customer Signature: |
| QUANTITY | PRODUCT CODE | SIZE | DESCRIPTION | TOTAL |
| SUBTOTAL | ||||
| SHIPPING | ||||
| MD RESIDENTS ADD 5.0% TAX | ||||
| TOTAL DUE |
| Order Total | up to $9.99 | $9.01 - $14.00 | $14.01 - $25.00 | $25.01 - $50.00 | $50.01 - $75.00 | $75.01 - $100.00 | $100.01 - $125.00 | $125.01 & Up |
| Shipping Charge | $0.95 | $3.95 | $4.95 | $5.95 | $6.95 | $8.95 | $11.95 | $14.95 |