ORDER FORM


Send to:

Express Depot
3568 Westshire Circle
Delavan, Wisconsin
53115-4234

Ordered by:

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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Depot Agent: Richard C. Burnes
Copyright © Express Depot
All Rights Reserved
Artwork courtesy of rrhistorical.com
This page was updated on October 19, 2001