Billing/Shipping and Payment Information
| Name |
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| Address |
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| City |
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| State |
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| Zip |
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| Country |
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| Phone |
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| E-Mail |
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| Check? |
I am enclosing a check for payment |
| Credit Card Type |
Visa
MasterCard
Discover
American Express |
| Credit Card # |
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| V-Code (# on back of card) |
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| Card Expiration |
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| Credit Card Holder |
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| Credit Card Signature |
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* Regular Shipping Chart
(Within Continental USA) |
| |
| up to $13.00 |
$5.75 |
| $13.01 to $24.00 |
$7.50 |
| $24.01 to $35.00 |
$7.85 |
| $35.01 to $48.00 |
$8.50 |
| $48.01 to $50.00 |
$10.00 |
| $60.01 to $75.00 |
$12.00 |
| $75.01 to $84.00 |
$13.00 |
| $84.01 up |
$14.00 |
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
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