Just fill this form out making sure you mark the QUANTITIES you wish after each item you wish to order. Upon receipt of this order form, you will receive your purchase within 7 to 14 days after your check clears. Please refer to www.DianeHein.com/pricing.htm for a complete list of items.
Make checks payable to: Diane Hein Mail your check and this form to:
Diane Hein
30617 U.S. 19 North Suite #420
Palm Harbor, Florida 34684
(just north of Clearwater, Florida)
| Purchased by: ______________________________________________________________________ |
| Ship to: ___________________________________________________________________________ |
| Address:___________________________________________________________________________ |
| City:______________________State:__________Zip/Postal Code:______________Country:_______ |
| Phone: (_____)__________________ Email address: ______________________________________ |
| QUANTITY | SIZE OF PHOTOS | NAME OF PHOTO OR ITEM DESCRIPTION | PRICE EACH | TOTAL |
| SUB TOTAL | ||||
| Florida residents add | 7.00% SALES TAX | |||
| SHIPPING & HANDLING | ||||
| AMOUNT ENCLOSED |
Summary for Shipping and Handling in the U.S.
Orders from $5.00 - $20.00 $4.00
S/H
Orders from $20.01 - $40.00 $6.00
S/H
Orders from $40.01 - $65.00 $8.00
S/H
Orders from $65.00 - $90.00 $9.50
S/H
Orders over $90.00
$10.00 S/H
Priority Mail on Any Quantity: Add $5.00
This is page two on the print out. If you need more space for
an order, you can use this one also.
| QUANTITY | SIZE OF PHOTOS | NAME OF PHOTO OR ITEM DESCRIPTION | PRICE EACH | TOTAL |