Jerilee’s Caribbean Pottery
ORDER FORM
[Jerilee is no longer making pottery. This site is available for demonstration
purposes only.]
HOW
TO ORDER: Print this form, fill it out and fax it to
[phone number] . . .
Print
this form, fill it out and mail it, along with your check, to [Name, Address,
City, State, Zip]. . .
Send
and e-mail to me at [e-mail address]- be sure to include your order and credit
card information.
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Style |
Bowl or Vase |
Size |
Price |
Shipping Charges(see
Note) |
Total |
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NOTE: Shipping charges
are as follows: Petite - $8.00, Small - $12.00, Medium - $18.00, Large -
$24.00. Amounts are for shipment to the
U.S. Mainland and Puerto Rico only. For
shipment outside these areas, we will call or e-mail you with the shipping
amount before your order is charged.
All pottery is shipped via insured U.S. Priority Mail. Please immediately notify us via fax or
e-mail if your shipment is damaged.
CUSTOMER
INFORMATION:
Shipping Name and Address Name:
_____________________________________________ Address:____________________________________________ City, State, Zip:
______________________________________ |
Billing Name and Address Name:
_____________________________________________ Address:____________________________________________ City, State, Zip:
______________________________________ |
*Your phone number:
_________________________ *Your fax
number: __________________________
*Your e-mail address:
_________________________ *We need
at least one so we can contact you.
CREDIT CARD INFORMATION: We accept Visa, MasterCard, _________________
Type of card:
_______________________________ Card
number:______________________________
Name as it appears on the card:
_____________________________
Expiration Date: ______________
These charges will appear on your credit card statement as __________________________________.
Your
personal information is for our use only and will be kept completely
confidential.
At no time
will your personal information be sold to or shared with another party.