jackcrisp.com
Form for mail, FAX, or phone orders. All Prices Are in USD

Shadow Marketing Group
100-1093 West Broadway, Vancouver, BC Canada V6H 1E2
Tel: 949-528-3809
Fax: 604-731-4569

Checks/Money Orders Payable to: Shadow Marketing Group
Credit Cards will be approved by Internet Secure
  BuckwheatFutons.com

Billing Information
Shipping Address (if different)
Name
____________________________________________
Name
_____________________________________________
Address
____________________________________________
Address
_____________________________________________
City                                     State             Zip
____________________________________________
City                                     State             Zip
_____________________________________________
Phone
____________________________________________
Phone
_____________________________________________
Email
____________________________________________
Email
_____________________________________________

 Description  Item Number  Qty  Unit Price  Total
         
         
         
         
         
   Sub-Total:  
 Shipping:  
 GST in Canada:  
 Grand Total:  

Call for shipping rate questions - Effective Date 2008

Order Total   U.S.A.   Order Total   Canada   Order Total   International*  
to $15.00   + $6.95   to $15.00   + $6.95   to $15.00   + $8.95+ $3/item
to $35.00   + $7.95   to $35.00   + $7.95   to $35.00   + $9.95+ $3/item
to $60.00   + $8.95   to $60.00   + $8.95   to $60.00   + $10.95+ $3/item
to $85.00   + $11.95   to $85.00   + $11.95   to $85.00   + $12.95+ $3/item
to $125.00   + $13.95   to $125.00   + $13.95   to $125.00   + $14.95+ $3/item
to $200.00   + $25.95   to $200.00   + $25.95   to $200.00   + $25.95+ $3/item
over $200.00   -CALL   over $200.00   -CALL   over $200.00 -CALL

* International shipping available to major countries including: the UK, Europe, New Zealand (except natural products), Australia, Asia. International rates are subject to price adjustment; if necessary we will contact you.

Method of Payment         ___ Check or International money order     ___ American Express, VISA, Mastercard, or Discover

Card # _______________________________________________________________ Exp. _______

Signature ___________________________________

Card Verification Number _________
(The last 3 digits on the signature panel on the back of MC or VISA; 4 digits on front of AE.)

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