Express Depot
3568 Westshire Circle
Delavan, Wisconsin
53115-4234
Name:________________________________
Street:________________________________
City:_______________________State:______
Zip:__________
Phone:(______)______-_________
E-mail_________________________
PART NUMBER | DESCRIPTION | LIST PRICE | QTY | TOTAL
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_______________|___________________________|____________|_____|_____________
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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