Printable Order Form

Please print and complete this form to help organize your order. When completed, you may:

Make checks payable to Vortex Innerspace Products, Inc.

Name:________________________________________________________________
 
Address:_____________________________________________________________
 
City:_____________________State:___________________ZIP:______________
 
Daytime Telephone Number: (_______)__________________________________
 
Evening Telephone Number: (_______)__________________________________
 
E-Mail Address:______________________________________________________
 
How did you find us? ________________________________________________
 
 Item                                            Unit          Total 
 Number Quantity     Description                 Price         Price 
  
 ____________________________________________________________________
 
 ____________________________________________________________________
 
 ____________________________________________________________________
 
 ____________________________________________________________________
 
 ____________________________________________________________________
 
 ____________________________________________________________________
 
                                     Merchandise Total ______________
 
                   Florida Residents Add 7% Sales Tax ______________
 
                                Shipping and Handling  ______________
 
                                                 TOTAL ______________
For charge card orders by mail or fax:
Visa[] MasterCard[] Discover[] American Express[]
 
Charge Card Number:_______________________________________________
 
Expiration Date:_________ Signature:______________________________
 
American Express & Optima only: Card Identification Number: ______ 

The Card Identification Number is four digits printed above the embossed charge card number on American Express and Optima cards.


Shipping & Handling Charges (USA Only)

Orders up to $10.00  . . . . . . . . . $8.98
Orders from $10.01 to $20.00 . . . . . $10.10
Orders from $20.01 to $30.00 . . . . . $11.07
Orders from $30.01 to $50.00 . . . . . $12.57
Orders from $50.01 to $100.00  . .  . $14.39
Orders Over $100.00 . . . . . ... ....$14.98
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