Beauty-Shopping.com Printable Order Form
Please Print Out This Form, Fill It Out, and MAIL to:
Simplex Services
POB 281,
Niverville, NY 12130
or FAX to
(518)758-8056
Name: ____________________________________________________________
Address: __________________________________________________________
City: _____________________________________________________________
State: _________ Zip: ___________ Country: ______________________
Home Phone: ___________________ Business Phone: _________________
E-mail: ___________________________________________________________
PAYMENT BY: Check: (Payable to Simplex Services) Amt. Enclosed: ___________
Master Card or Visa: __________________ Exp. Date: _______________
Credit Card Number: _______________________________________________
Signature:_________________________________________________________
Please Charge My Card: Visa _____ Mastercard _____ (check one)
Product Name Price Qty. Total$
____________ _________ ______ _________
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Shipping & Handling Fees: Subtotal: _________
US Canada/Mexico
Up to $10.00 $ 3.25 $ 7.50 S & H : _________
$10.01-$40.00 $ 6.50 $15.00
$40.01-$70.00 $ 9.75 $19.30
Over $70.00 $12.90 $22.50
NY Residents add TaxRate: 8% Tax : _________
Total: _________
Simplex Services - POB 281, Niverville,
NY 12130
Phone and Fax: (518)758-8056