ORDER FORM

ITEM #	DESCRIPTION	PRICE ea.	QUANTITY	TOTAL







Shipping / Handling charges Continental U.S. only. Email for other destination charges.		SUB TOTAL:
$5.00 - $25.00 = $6.00 $25.01 - $50.00 = $7.00		TAX 8.25% (CA only):
$50.01 - $70.00 = $10.00 $70.01 - $150.00 = $13.00		SHIPPING/HANDLING:
$150.01 - $500.00 = $15.00 $500.01 - and up = $20.00		GRAND TOTAL:

Payment in US$: (Check one) Payable to: NICHI BEI BUSSAN
		Money Order
Cashier's Check	Personal Check	(allow 15 business days to process)
Credit Card Number Required if Credit Card is used
Credit Card V-CODE Required if Credit Card is used The V-Code is located on the back of your credit card. It is the last 3 numbers on the right side of the signature line.
Expiration Date (mm) (yy) Required if Credit Card is used

If you wish to use a credit card but do not want to enter it on-line, you
may call us, with your credit card number, at (408) 294-8048.

Name:	required	If you would like your merchandise shipped to a different address, please tell us in the comments box below.
Billing Address:	required
City:	required
State:	required
Country:	required
Zip Code:	required
Email:	required
Home Phone:

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Areas of interest:
Martial Arts Fabrics Fashion Home Decor Crafts Books Children's Merchandise Other (please specify in comments box below)

Any Comments or Questions?

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