Printable Order Form  

Please make Checks or Money Orders payable to: Tyra Wolthuis
Send this order form with a check or money order to:

Tyra Wolthuis
P.O. Box 63482,  Phoenix,  AZ  85082

Item Number

Brief Item Description

Price
per Item

Qty

Total
         
         
         
         
         
         
         
         
         
         
         
 

Sub-Total $______________

Shipping $______________

TOTAL REMITTED $______________


USE THE CHART BELOW TO FIGURE OUT YOUR SHIPPING
Minimum Purchase Maximum Purchase Shipping
$.01 $24.99 $6.50
$25.00 $74.99 $8.50
$75.00 $124.99 $10.50
$125.00 $249.99 $18.50
$250.00 >>> UP FREE

Name: _______________________________________
Address 1: ____________________________________
Address 2: ____________________________________
City: _______________ State: ______ ZIP: __________
Home Phone: ____________________
Work Phone: ____________________
Cell Phone: ______________________
e-mail address: ________________________________