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Complete Form and Fax or Mail to:
AllHeart PO BOX 352 Louisiana, MO 63353 fax: (660) 263-1239 |
| Bill To: | Ship To: | ||||
| Name: | Name: | ||||
| Address: | Address: | ||||
| City: | State: | Zip: | City: | State: | Zip: |
| Phone: | Phone: | ||||
| e-mail address (needed for order/shipping confirmation): | |||||
| item # | color | size | qty. | item description | price each | total price |
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Satisfaction Guaranteed! If you're not completely satisfied with any merchandise you have received, just return it within 30 days of receipt for a full refund or exchange. (Some exceptions apply.) |
Shipping & Handling (see chart below): | |||||
| Order Subtotal: | ||||||
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Sales Tax - California Residents Add 9.75%: Missouri Residents Add 7.725%: Duties & Taxes - Canada Residents Add 18%: |
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| Gift Certificate Number: Subtract Gift Cert. Value: | ||||||
| Internal Code: Fax or Mail Your Order Total Due: | ||||||
| Shipping Method (check one) __ U.S.A. __ International | |||||||
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U.S.A. Order Amount $0.00 to $14.99 = $15.00 to $25.99 = $26.00 to $49.99 = $50.00 to $74.99 = $75.00 to $99.99 = $100.00 to $199.99 = $200.00 to $499.99 = $500.00 & up = |
Smart Post $6.99 $8.99 $10.99 $12.99 $14.99 $16.99 $19.99 4.0% |
Premium Ground* $9.99 $12.99 $14.99 $16.99 $18.99 $20.99 $23.99 5.5% |
3-Day Air $14.99 $15.99 $18.99 $19.99 $20.99 $22.99 $27.99 6.0% |
2-Day Air** $19.99 $20.99 $23.99 $24.99 $25.99 $27.99 $32.99 7.0% |
Next Day Delivery $36.99 $37.99 $40.99 $41.99 $42.99 $44.99 $49.99 10.5% |
Canada Taxable Amount $0.00 to $14.99 = $15.00 to $49.99 = $50.00 to $99.99 = $100.00 to $149.99 = $150.00 to $199.99 = $200.00 to $349.99 = $350.00 to $499.99 = $500.00 to $999.99 = $1000.00 up = |
Canadian Shipping Rate $24.99 $29.99 $33.99 $35.99 $39.99 $42.99 $44.99 $70.99 8.0% |
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Note: There is a $10 surcharge for deliveries to Alaska and Hawaii.
* Premium Ground Service is only available in the 48 contiguous United States. Not available in AK and HI. ** 2-Day Air is not available when shipping to a P.O. Box address. Your order will be delivered on the 2nd Business Day (Business Days are M-F excluding Holidays) after date of order if the order is received by 2:00pm CST. (Note: The schedule above is ONLY an estimate, not a guarantee. All shipping is out of St. Louis, MO.)
Mexico, Japan, Italy, Netherlands: Add $3 US Dollars per item plus the rate.
All Other Countries: Add $10 US Dollars per item plus the rate. |
All Other International Taxable Amount $0.00 to $14.99 = $15.00 to $49.99 = $50.00 to $99.99 = $100.00 to $149.99 = $150.00 to $199.99 = $200.00 to $349.99 = $350.00 to $499.99 = $500.00 to $999.99 = $1000.00 up = |
All Other International Shipping Rate $22.49 $31.49 $34.49 $41.49 $45.49 $61.49 $68.49 $75.49 $96.49 |
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Payment Method. Sorry, no CODs. (check one)
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| Print Name on Credit Card: | |
| Credit Card Number: CID: | Expiration Date: |
| Signature: | Today's date: |
Please Note: Checks must be drawn from U.S. banks. ©2011 Scrubs AC, Inc. - AllHeart.com®
© 2013 by Scrubs AC, Inc.
