Baskets Order Form

SHIP TO: PLEASE PRINT Name ____________________________________________________ Street Address _______________________________ Apt. # ________ City ______________________ State _______ Zip ________________ Phone (______)________________ Email _______________________

METHOD OF PAYMENT (NO CASH or COD):  Visa   Master Card   Discover   Money Order   Personal Check Credit Card # __________________________ Expiration Date ______________ Signature as it appears on card _______________________________________

NUMBER	DESCRIPTION	STAIN	QUANTITY	PRICE	TOTAL
Subtotal
PA Residents add 6% Sales Tax (7% in Allegheny County)
Shipping
TOTAL

Note: In the stain column - please enter U for unstained, M for maple stain, or W for walnut stain.

Merchandise Total Shipping Rate $49.99 & Under $12.50 Due to the high cost of shipping please contact me for sales of $50 or more.

Please print this form, fill it out completely, and mail to: The Basket Man 4960 William Flynn Hwy. Suite# 6- PMB 136 Allison Park Pa. 15101

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