Alan Lacer's Order Form

Date:

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Name and Mailing Address:
Please print,
and mail or fax to:
Alan Lacer
299 Plainview Dr.
River Falls, WI 54022
or
Phone/Fax: (715) 426 9451
Quantity Item Description Price
$
$
$
$
$
$
$
$
Total Of All Merchandise: $
Shipping and Handling Charges* $
Buy any 3 titles and deduct $5 from total invoice
Buy any 4 titles and deduct $10 from total invoice
Buy and 5 titles and deduct $15 from total invoice
Buy any 6 titles and deduct $20 from total invoice 		$
Wisconsin residents add 5.5% sales tax   
Total Amount Due: $
*Calculating shipping (U.S. orders only. For all orders outside the U.S. please contact me for shipping costs) Shipping costs are based on Total Of All Merchandise:
Under $50 add $5  -  $51 to $75 add $7  -  $76 to $120 add $9  -  $121 to 200 is $11  -  Over $200 is $18

Phone Number:
e-mail:
Payment by: Visa Master Card Check Money Order
Card No.
Exp. Date: Month: Year:

Signature _______________________________________

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