CHECK OR MONEY ORDER PAYABLE TO: PURCHASE ORDER FORM
SHANE, INC.
SHIP TO: Type or print clearly SHIP VIA: UPS___ Parcel Post___ Residential___
NAME:________________________________ THIS ORDER IS NEEDED BY: _________________
CHAPTER:_____________________________ You will be advised if the delivery date cannot be met.
ADDRESS:_____________________________ Orders must be followed up with a check or money order.
CITY, STATE: __________________________ No credit cards accepted.
ZIP CODE:_____________________________ Item #________ (Number of characters and lines unlimited)
PHONE NO: ___________________________
FAX NO: ______________________________
ITEM # QUANTITY UNIT PRICE TOTAL
_______ _______ $_________ $_________
_______ _______ $_________ $_________
_______ _______ $_________ $_________ Item #________ (Number of characters and lines unlimited)
_______ _______ $_________
$_________
_______ _______ $_________ $_________
_______ _______ $_________ $_________
_______ _______ $_________ $_________
_______ _______ $_________ $_________
_______ _______ $_________ $_________ Continued on page 2
Grand Totals: $_________ $_________
SHIPPING & HANDLING RATES
Item #________ (Number of
characters and lines unlimited)
$0.00 $49.99 Add - $7.50
$50.00 $249.99 Add - $9.50
$250.00 and up Add - $12.00
Residential Delivery - Add $1.50 extra International Orders - will be advisedProduct Total $______________ If you have any additional engraving,
Engraving Total (.13 per character) $______________ please use an extra order form or a
S&H Total $______________ plain sheet. Type or print clearly.
Grand Total $______________
This order form is for mail or fax orders ONLY!
Step 1. Print this order form and fill in the necessary information.
Step 2. Mail or fax your order to the address above.
Step 3. Enclose your payment via mail.
Option: Or email your order by using our online order form.