PriorService.com Printable Order Form
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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 |