Rag Tag and Whimsey
Order Form
Print and fax or mail to:
Terri Guenthner
126801 SR 26
Colfax, WA  99111
Phone or Fax:  1-509-397-9156
E-mail:  [email protected]
Bill To:                                                         Date:____________
Name ____________________________________________
Address___________________________________________
City______________________ State_________ Zip ________
Phone ____________________E-mail___________________

ShipTo: (If different than above)
Name_____________________________________________
Address___________________________________________
City _____________________ State _________Zip _________
Quantity  -  Item #             Description            Unit Price        Total Price

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

                                                                                            Subtotal _____________
Make Check out to:                                              Tax ______________
       Terri Guenthner                                    Shipping ______________
                                                               Balance Due ______________

Credit Card Information:   (We accept Visa and Mastercard)
    (We do not have a secure sight so please do not e-mail this information.)
Visa  ____  MasterCard ____
Card # _________________________
Expiration Date ___________________

Signature _______________________________________________

Shipping Rates:
               Up to $ 20.00    Add $6.50
         $20.01  - $ 35.00    Add $8.50
         $36.01 - $  50.00    Add $10.00
         $50.01 - $  75.00    Add $15.00
         $75.01 - $100.00    Add $20.00
         Add $5.00 for each additional $25.00
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