ORDER FORM
PRINT AND MAIL TO:
ELLM, INC
PO BOX 2945
Berkeley, CA 94702-0945
NAME:_____________________________________________________DATE______________
ADDRESS______________________________________________________________________
CITY____________________________________STATE________________ZIP______________
PHONE_________________________________________
Qty___
ITEM__________________________________ COST EACH_________
SUB_TOTAL________
Qty___
ITEM__________________________________ COST EACH_________
SUB-TOTAL________
Qty___
ITEM__________________________________ COST EACH_________
SUB-TOTAL________
Qty___
ITEM__________________________________ COST EACH_________
SUB-TOTAL________
Qty___
ITEM__________________________________ COST EACH_________
SUB-TOTAL________
Qty___
ITEM__________________________________ COST EACH_________
SUB-TOTAL________
SUB TOTAL__________
SHIPPING (from rate chart)____________
TOTAL___________
Shipping Rates:
|
From(USD) |
To(USD) |
Rate(USD) |
|
0.01 |
100.00 |
7.00 |
|
100.01 |
150.00 |
10.50 |
|
150.01 |
200.00 |
14.00 |
|
200.01 |
250.00 |
17.50 |
|
250.01 |
and up |
21.00 |