Kirk News Mail Order Form:
| Return to the Order Page |
|
Name: |
|
|
Street Address: |
|
|
Address 2 (if needed) |
|
|
City, State and Zip: |
|
|
Country |
|
|
E-mail: |
|
Phone: [ ] Day or [ ] Evening |
( ) |
Special instructions:
Order information (click here to see an example)
|
Product Name and Description |
PRICE |
QUANTITY |
TOTAL |
| Prescription Guide To Mexico and Canada | $14.95 | ||
| Prescription Guide To Europe and Canada | $14.95 | ||
| Prescription Guide To Mexico, Europe and Canada | $24.95 | ||
|
(Standard Shipping and Handling for all orders) |
5.00 |
||
|
Subtotal |
|
||
|
No
additional charges for standard USPS shipping to
|
|||
|
Additional Shipping Fee For
Express USPS shipping
U.S. 50 States and Territories |
|||
|
Additional Shipping
and Handling Charge for
CANADA ONLY
|
|||
|
(Additional Air Mail Shipping and handling Fee for all Western European countries)
|
|||
|
(Additional Priority Shipping and handling for European countries) |
|||
|
Subtotal
|
|
||
|
TOTAL |
|
||
Please make your
check or money order
payable to
Kirk News,
Please send check or
money order (U.S. funds only) to:
Instructions: Please print the above form on your printer. With your mouse
HIGHLIGHT everything above these instructions. Click the FILE
option
in the upper left corner of this screen. Go down the options to
PRINT
option and click it. When the new window opens, click the
SELECTION
button. Then click the OK Button. When the above
form prints out,
fill out form as necessary, refer to the example below if
necessary, then
send it along with payment to the
above address.
| Return to the Order Page |
Contact and billing information:
|
Name: |
John
Doe
|
|
Street Address: |
5555 Oak Street
|
|
Address 2 (if needed) |
Suite 3B
|
|
City, State and Zip: |
Mountain Town,
NY 10433
|
|
Country |
USA
|
|
E-mail: |
john@dot.com |
|
Phone: [ X ] Day or [ ] Evening |
( 222 ) 222-2222 |
Special instructions:
| Do not ship Until Monday. I will be
back from my business trip then. Thank you.
|
Order information
|
Product Name and Description |
PRICE |
QUANTITY |
TOTAL |
| Prescription Guide To Mexico and Canada | $14.95 | ||
| Prescription Guide To Europe and Canada | $14.95 |
1 |
14.95 |
| Prescription Guide To Mexico, Europe and Canada | $24.95 | ||
|
(Standard Shipping and Handling for all orders) |
5.00 |
||
|
Subtotal |
19.95 |
||
|
No
additional charges for standard USPS shipping to
|
|||
|
Additional Shipping Fee For Express USPS shipping U.S. 50 states and territories (Available only with Money Order) Add $20.00 |
|||
|
(Additional Shipping
and Handling Charge for
CANADA ONLY)
(U.S. funds only)
|
|||
|
(Additional Air Mail Shipping and handling Fee for all Western European countries)
|
|||
|
(Additional Priority Shipping and handling for European countries) |
|||
|
Subtotal
|
19.95 |
||
|
TOTAL |
19.95 |
||