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