Rhinestone-Tiaras USA
Retail Order Form

Please print this 2-page form and fill it out.

Fax your order to (515) 277-3414,
Or mail it to:  400 Maple Street
  West Des Moines, IA 50265-4721
 
Orders are usually processed and shipped the same day or the following day.

The Shipping Department operates Monday through Friday 9am - 5:00pm.
 No orders are processed or shipped on weekends and holidays.

 Today's Date:  Date Required:

 
BILLING & SHIPPING ADDRESS:
Must be the same as your credit card billing address.
 

 Name:
 Company Name:
 Street Address:
 City:  State:  Zip:
 Daytime Phone:  Fax:
 E-mail:

 
METHOD OF PAYMENT:
Check One
 

 ___Visa        ___Mastercard        ___Discover        ___American Express

___Certified Check      ___Cashier's Check      ___Money Order
___Personal or Company Check

Sorry No COD's

  

 Cardholder's Name:
 Card Number:  Exp:
 "V" Code (Last 3 digits in signature space on back of card):
 Signature:
 Driver's License Number or Company ID if paying by Check:

 

WHEN SHIPPING TO A  P. O. BOX, WE CAN ONLY

USE PRIORITY MAIL

OR NEXT DAY DELIVERY BY USPS

.

.

Please be sure to indicate Size and Color for each item, where applicable.

Quant.

 Stock Number

Item Description Size

Color

 Price

Total Price

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STANDARD SHIPPING BY UPS GROUND
 (ALLOW 3 TO 7 BUSINESS DAYS)

Order Total:

Shipping & Handling:    

$00.00 to $25.00 ........................................................................................... $10.25
$25.01 to $50.00 ........................................................................................... $11.50
$50.01 to $75.00 ........................................................................................... $12.75
$75.01 to $100.00 ........................................................................................... $14.75
$100.01 to $150.00 ........................................................................................... $16.00
$150.01 to $200.00 ........................................................................................... $18.00
$200.01 to $300.00 ........................................................................................... $18.75

Over $300.00    ............................................................................................................ 6% of Order Total

PLEASE CALL 1-800-383-7469 FOR AIR SHIPMENT CHARGES

Please note: large or heavy items can substantially increase shipping and handling charges

Sorry No COD's.  INTERNATIONAL ORDERS Please call or e-mail for shipping rates.


Return and Exchange Policy
Please acknowledge that you have read our return/exchange policy. It is required to complete your order.

______  No, I have not read the return/exchange policy.
______  Yes, I have read the return/exchange policy and I agree.

 
 
 
 
 
$________

(Shipping)

     

Iowa residents add 6% tax:  

 $
   

Total.Enclosed:  

 $

 

Return to To Order Page

Page Revised Jan 2, 2009