Nokie Edwards Fan Club - USA
OFFICIAL MERCHANDISE MAIL ORDER FORM

FIRST PRINT THIS FORM

USA ORDERS ONLY - CHECK/MONEY ORDERS Please print and fill out this form completely and staple together and mail with check or money order. Please make sure all entries are legible and correct and please do not abbreviate anything.

Date: _____________________

Name: ______________________________________________________________________________

 Address: ____________________________________________________________

City: __________________________________________  State: _______________________________

ZIP Code: _____________ + _____________

Telephone Number: (_______)___________________


E-Mail  Address: _____________________________________________________________________

PLEASE UNDER DESCRIPTION PLACE ITEM NUMBER

QTY

DESCRIPTION

COLOR

SIZE

PRICE EACH

AMOUNT

NOTE: USA ORDERS ONLY! (International orders taken online only.) Please allow 3-4 weeks for processing & delivery. Please use table below to figure your shipping charge.

PRIORITY MAIL SHIPPING
Subtotal Amount	Shipping Charge
Up to $15.00	$3.95
$15.01 - $30.00	$7.90
$30.01 - $60.00	$15.80
$60.01 - $120.00	$31.60
$120.01 - $240.00	$63.20

� Money Order enclosed		Sorry no credit cards at this time		� Personal Check enclosed

Make payable and mail to:
28150 N. Alma School
# 103 - 141
Scottsdale, Arizona
85262
 

Sub
Total

US Priority Mail Shipping (from table)

Add Handling Charge

$1.00

Add signature confirmation to order

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