Rhinestone-Tiaras USA
Retail Order Form

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
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
.	.			.	.	.
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