| Billing Address:* | Ship To: (if different) |
|---|---|
| Name: | Name: |
| Address: | Address: |
| City: | City: |
| State:_________Zip Code: | State:_________Zip Code: |
| E-mail Address: | E-mail Address: |
| Phone Number: | Phone Number: |
| QTY: | SIZE: |
|
ITEM COLOR: | UNIT PRICE: | TOTAL: |
|---|---|---|---|---|---|
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ | |
| - | - | - | $ | $ |
| Merchandise Total: | $ |
| Shipping FREE if Shirt/s shipped in USA: | $ |
| TOTAL: | $ |
| ___Money Order
Enclosed (make M.O. payable to Charm & Happy) |
$_________________ |
| Mastercard | _____ | Visa | _____ | American Express | _____ | Discover | _____ |
|
CARD NUMBER:__________________________________EXP DATE:____-____ SIGNATURE: (Required on all credit cards)___________________________________ *Must agree to credit card billing address, if using credit card. |
|
|
|
|
| Up to $25 | $8 | |
| $26 - $50 | $10 | |
| $51 - $75 | $12 | |
| $76 - $100 | $14 | |
| $101 - up | $16 |