MyCrystalGift.com Product Order Form
 Fax Order Form to: (203) 264-5718
Name __________________________________
Phone No. __________________________________
Fax No. __________________________________
VISA/MC/AMEX No. ______________________________
Card Security Code ______________________________
Exp. Date ______________________________
Signature ______________________________
Shipping Address Cardholder Name and Billing Address
O WholeSaler   O Individual
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Product Description

 Quantity

 Unit Price

 Extension
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Domestic Shipping:
Signature Required?   OYes   ONo 		Subtotal _____________
O FedEx Ground $5 + 4% of subtotal.
 
 O FedEx 2-Day    $10 + 8% of subtotal
 
 O FedEx Std. Overnight    $20 + 12% of subtotal
 
International Shipping:
 
O APO Priority Mail   $15 + 8% of subtotal
 
 O FedEx Canada   $20 + 12% of subtotal
 
 O FedEx Europe   $30 + 15% of subtotal
 
 O FedEx Japan   $30 + 15% of subtotal
 
 O FedEx Other   $40 + 20% of subtotal
 
 		6.00% Tax
(CT Only)		  
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Shipping		  
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Total
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
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MyCrystalGift.com, P.O. Box 167, Southbury, CT 06488 USA
1-203-271-9195 ; Fax 1-203-264-5718

Products, specifications and prices subject to change without notice. ©2006.