ORDER FORM

ITEM #
DESCRIPTION
PRICE ea.QUANTITYTOTAL
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
Visa MastercardMoney Order
Cashier's CheckPersonal 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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