FOX DEN LTD ORDER FORM

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PO box 1000 Pinehurst NC 28370
  Delivery Address:
Hours 9-5 M-F.  Outside of normal hours, leave phone number and time we should call back.  

2020 Juniper Lake Rd. West End, NC 27376

Phone (910)215-9970 | FAX (910)215-0996 | Toll Free (877)463-0956
Ship to
A-D		 Item Description Item # Color Size Qty Gift Wrap
$5.00		 Price
Each  		 Total
Price
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 
                 

Subtotal

 $

Standard shipping per address
Oversize shipping (see item description)

 $
$

NC residents add 7.0% tax

 $

Total

 $


Standard ground shipping/handling for deliveries within the 48 contiguous state
Additional oversize charges are in parentheses after item price
Call for express shipping rates
Payment Method [ ]VISA [ ]MC [ ]check [ ]Amex
[ ]Money Order		   Purchase Amount Add
Credit Card Number     Under $15.00 $5.95
Exp Date     $15.01 - $30.00 $6.95
Signature     $30.01 - $45.00 $8.95
Print name on card

 

   $45.01 - $60.00 $9.95
Bank Name (VISA/MC)     $60.01 - $70.00 $10.95
      $70.01 - $80.00 $11.95
      $80.01 - $100.00 $12.95
      $100.01 - $140.00 $13.95
      $140.01 - $175.00 $15.95
      Over $175.00 $16.95

 

 

 

 

 


CUSTOMER INFORMATION                                                        Acct #

A

 Name __________________________ __________________________ ____        ____
Ordered

First

Last

 M.I.           Title
By: Phone __________________________ __________________________ _________________

Daytime

Evening

Cellular
Email __________________________
Billing Address 1 __________________________ __________________________ __________________
Address: Address 2 __________________________ __________________________ __________________
Address 3 __________________________ __________________________ __________________

City

State

Zip

--------------------

B

 Name __________________________ __________________________ ____        ____

First

Last

 M.I.           Title
Delivery Address 1 __________________________ __________________________ __________________
Address: Address 2 __________________________ __________________________ __________________
(if different Address 3 __________________________ __________________________ __________________
from A)

City

State

Zip

--------------------

C

 Name __________________________ __________________________ ____        ____
Gift

First

Last

 M.I.           Title
Recipient Address 1 __________________________ __________________________ __________________
Address: Address 2 __________________________ __________________________ __________________
Address 3 __________________________ __________________________ __________________

City

State

Zip
Delivery ______________________________ __________________________

Date

Occasion
Message __________________________ __________________________ __________________

--------------------

D

 Name __________________________ __________________________ ____        ____
Gift

First

Last

 M.I.           Title
Recipient Address 1 __________________________ __________________________ __________________
Address: Address 2 __________________________ __________________________ __________________
Address 3 __________________________ __________________________ __________________

City

State

Zip
Delivery ______________________________ __________________________

Date

Occasion
Message __________________________ __________________________ __________________