Mail in Form-Chocolate Jigsaw Puzzle Molds

CHOCOLATE

JIGSAW PUZZLE MOLDS

Mail Order Form

We DO NOT accept explicit or obscene material.

Mail to:
Joslin Photo Puzzle Co.
302 Bel Air Road
Southampton, PA 18966-3322

Orders are shipped within 5 work days (Mon-Fri) of receipt.
Please understand we have no control over delivery times by ANY postal carriers.

PRODUCT	SHAPE	Size When Completed	# of Pieces (circle one)	How Many?	Cost Ea.	Sub-Total
CHOCOLATE JIGSAW PUZZLE MOLDS	RECTANGLE	8" x 10"	12		$25.00
CHOCOLATE JIGSAW PUZZLE MOLDS	HEART	7.5"	8		$25.00

Subtotal:
* Add Regular Shipping: (see chart below)
"SPECIAL SHIPPING REQUEST (Within Continental US), additional cost" 3 Day UPS-Add $7.00 2 Day Air-Add $12.00 Next Day Air-Add $30.00
RUSH Service - Shipped in 2 working days (Within Continental US) Double the puzzle cost and add $30 for next-day air
Outside USA-Add $15.00
Pa. Residents add 6% sales tax;( Phila. PA add 8% sales tax & Allegheny County PA add 7% sales tax)
Total Enclosed US Funds

MAKE CHECKS PAYABLE TO:JOSLIN PHOTO PUZZLE CO.

Billing/Shipping and Payment Information

Name
Address
City
State
Zip
Country
Phone
E-Mail
Check?	I am enclosing a check for payment
Credit Card Type	Visa MasterCard Discover American Express
Credit Card #
V-Code (# on back of card)
Card Expiration
Credit Card Holder
Credit Card Signature

* Regular Shipping Chart
(Within Continental USA)


up to $13.00	$5.85
$13.01 to $24.00	$7.60
$24.01 to $36.00	$7.95
$36.01 to $48.00	$9.50
$48.01 to $58.00	$10.50
$58.01 to $65.00	$11.00
$65.01 to $75.00	$12.00
$75.01 to $84.00	$13.00
$84.01 to $125	$15.00
$125.01 and up	$17.00

Mail to:
Joslin Photo Puzzle Co.
302 Bel Air Road
Southampton, PA 18966-3322 USA
Be sure to include the following: This completed order form Your photo or CD Your check or credit card info