Express Depot
3568 Westshire Circle
Delavan, Wisconsin
53115-4234
Name:________________________________
Street:________________________________
City:_______________________State:______
Zip:__________
Phone:(______)______-_________
E-mail_________________________
PART NUMBER | DESCRIPTION | LIST PRICE | QTY | TOTAL ---------------|---------------------------|------------|-----|------------- _______________|___________________________|____________|_____|_____________ _______________|___________________________|____________|_____|_____________ _______________|___________________________|____________|_____|_____________ _______________|___________________________|____________|_____|_____________ _______________|___________________________|____________|_____|_____________ _______________|___________________________|____________|_____|_____________ _______________|___________________________|____________|_____|_____________ _______________|___________________________|____________|_____|_____________ Total merchandise . . . . . . . . . . . . . . . . . . . . . . _____________ If total merchandise is $100.00 or more, deduct 10% . . . . . _____________ Net merchandise . . . . . . . . . . . . . . . . . . . . . . . _____________ Shipping & handling charges: Net merchandise Add shipping and handling ----------------- ------------------------- Up to $15.00 $ 4.95 $15.01 to $25.00 5.95 $25.01 to $50.00 7.95 $50.01 to $75.00 8.95 $75.01 to $100.00 9.95 $100.01 to $125.00 10.95 $125.01 to $150.00 12.95 Over $150.00 15.00 _____________ Net merchandise plus shipping and handling . . . . . . . . . . _____________ Wisconsin residents must add 5.5% sales tax . . . . . . . . . _____________ Total due (check or money order; sorry, no credit cards) . . . =============
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