First Name: _____________________

Last Name: _____________________

Address: _______________________________ Apt.#: __________

City: _______________________ State:_______ Zip Code: _________________

Phone: ________________________

E-mail: ___________________________________

Product Description:(e.g. glass hummingbird)

Item No.

Price Each

Quantity

Total for Line

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Sub-Total _____________

Discount Amount_____________

*Sales Tax(if applicable) _____________

Shipping _____________

Total Amount _____________

Packing & Shipping Chart
These charges represent only a part of the actual costs. We'll pay the rest. If your order is:

up to $14.99,……………………………………....add $3.05
from $15.00 to $19.99,…………………………….add $3.35
from $20.00 to $24.99,…………………………….add $3.65
from $25.00 to $29.99,…………………………….add $4.45
from $30.00 to $34.99,…………………………….add $5.05
from $35.00 to $39.99,…………………………….add $6.00
from $40.00 to $44.99,…………………………….add $6.80
from $45.00 to $49.99,…………………………….add $7.60
over $50.00,……………………………………….add $8.10

* Only Indiana Residents Apply 5% Sales Tax.
No Sales outside the Continental US.