Broward County Store Printable Order Form
655 West Prospect Road, Fort Lauderdale, FL 33309
Phone: (954) 565-2711 Fax: (954) 565-2775

Item No
Item
Color
Price
Qty
Size
Total
             
             
             
             

SHIPPING RATES
Order Total
Shipping Cost
$25.00
$4.95
$25.01-$50.00
$6.95
$50.01-$75.00
$8.95
$75.01-$100.00
$10.95
$100.01-$150.00
$12.95
$150.01-$200.00
$15.95
$200.01 and over
$17.95
= TOTAL
STATE SALES TAX
SHIPPING
GRAND TOTAL DUE
 
 
 
 

METHOD OF PAYMENT
CHECK OR MONEY ORDER ENCLOSED (made payable to Sharp Marketing)
Visa Mastercard AMEX
Card #: Exp. Date:

SOLD TO
Name  
Address

 

 
Phone: Fax:
E-mail  
SHIP TO Leave blank if same with Sold To.
Name  
Address

 

 
Phone: Fax:
E-mail