Southern Rose Architectural Specialties
P.O. Box 280144     Columbia, SC     29228      (803) 356-4545

INSTRUCTIONS - PRINT THIS FORM WITH YOUR BROWSER'S
"PRINT" BUTTON, COMPLETE THE FORM,
THEN MAIL YOUR ORDER TO ABOVE ADDRESS
(OR PLACE YOUR ORDER BY PHONE @ (803) 356-4545).
  Ordered By Ship To (If Different)
Name    
Address1    
Address2    
City/State/Zip    
Date    
Phone #    

 

Quantity Stock # Description Unit Price Total Price
         
         
         
         
         
         
Shipping and Handling Table - Merchandise Total  
Order             S&H          Order             S&H Shipping and Handling  
$00 - $25 $ 5 $101 - $125 $16 Motor Freight (Call)  
$26 - $50 $9 $126 - $150 $18 Credits  
$51 - $75 $12 $151 - $200 $20 5% Sales Tax (SC Only)  
$76 - $100 $14 Over $200 10% Total Due  

 

Method of Payment (Circle One)       Check       MoneyOrder       Visa        MasterCard
Credit Card Number  __ __ __ __ -- __ __ __ __ -- __ __ __ __ -- __ __ __ __
Expiration Date
Signature
Note - If credit card billing address is different than above addresses, please provide
the credit card billing address below. This is needed for credit card verification purposes.

visa.gif (7918 bytes)     Master.Card.gif (6743 bytes)

WE APPRECIATE YOUR BUSINESS !

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