EAGLE   GIFTS   GALORE
2707 S. DESERT FOREST AVE., ONTARIO, CA 91761   Voice: (909) 947-6634
Fax: (909) 947-6666     e-Mail:  EagleGiftsGalore@gmail.com     http://www.EagleGiftsGalore.net
CERAMIC  WB  PATROL  ANIMAL   BEADS  ORDER  FORM

Fill in and print this form, sign it, and Fax or mail it to the address above.
Please do NOT send Credit Card information via eMail.
All prices subject to change.



ANIMAL QUANTITY ANIMAL QUANTITY
   
   
Beads . . . . . . . $ 2.75 each.
Shipping & Handling:
1 - 3 Beads First Class Mail $   3.50
4 - 10 Beads First Class Mail $   5.50
11 + Beads USPS Priority Mail $   7.75
California Residents add 7.75% Sales Tax.

ORDER   SUMMARY
 
Total # of Beads     @     $   2.75   =  $   
Calif. Sales Tax *   @     7.75%   =  $   
Shiping & Handling   @   $    =  $   
Total Order   =  $ 
* California Residents only

Billing Address
  Name          
 Address 1    
 Address 2    
 City              
 State                      Zip      
 E-Mail    
    Main Phone Number
   Home       Mobile  
    - -
  Second Phone Number
   Mobile       Work  
    - -

Shipping Address (if different)
We must have a phone number for the shipping address.
  Name          
 Address 1    
 Address 2    
 City              
 State                      Zip      
    Phone Number
    - -

PAYMENT   INFORMATION:
     Check Enclosed      Credit Card      PayPal    
Send PayPal payments to EagleGiftsGalore@gmail.com
 
CREDIT  CARD   INFORMATION:
Name on Credit Card:
First Name Middle Initial Last Name
Please make sure that the Billing Address (above) is where the credit card statement is sent.
  Credit Card Type:      Visa     Mastercard
CREDIT   CARD   NUMBER: EXPIRATION   DATE: SECURITY   CODE:
    (on back of card)
                  
 
 
Signature: ________________________________________________________________________________



Rev. 03-2018