Fax & Mail Order Form

Ordering by Fax:          1 (661) 948-1136 Ordering by mail:          Miscellany         P.O. Box 1377         Lancaster, CA 93584 Thanks very much for shopping at Miscellany! Simply print out this page, fill in the information requested and fax it to our order hotline, or mail it via snail mail. First Name: ______________ M.I.: ___ Last Name: ______________ Daytime phone (area code)______(number)______________ E-Mail:____________________________ Type of Credit Card:MastercardVisaDiscover Credit Card Number:___________________Expiration Date:__________ Billing Address for Credit Card: Name: __________________________________________ Street 1: __________________________________________ Street 2: __________________________________________ City: _____________________ State:_____ Zip: _______________ Shipping Address for Merchandise (if different from Billing Address above) Name: __________________________________________ Street 1: __________________________________________ Street 2: __________________________________________ City: _____________________ State:_____ Zip: _______________ Your Signature: _______________________ (We must have your signature to process your order) Order Form DESCRIPTION ITEM # PRICE Shipping Rates Continental U.S. only $ 0 to $20.00 add $4.40 $20.01 to $50.00 add $6.90 $50.01 and over add $10.00 Sub Total CA Sales Tax* Shipping Total * CA Sales Tax is for California residents only. The rate is 8.25%. ©Miscellany 1997 - 2002