Melonious Merchandise            Order Form

                               26 Southpointe Drive

                               Charleston, WV 25314

                               304-744-1691  fax:  304 744-1479

                               whjernigan@charter.net

Melonious

Billing Address

Mailing Address if different from Billing Address

Name:

 

Name:

 

Address:

 

Address:

 

 

 

 

 

City, State Zip

 

City, State Zip

 

FAX:

 

FAX:

 

Phone:

 

Phone:

 

 

 

 

 

 

 

 

SHIPPING AND PAYMENT

Merchandise will be shipped via Ground UPS, with an estimated delivery time of 5-11 business days from the
time the order is shipped.  Call for large orders or special shipping arrangements.

o  Check:  Print order and mail with check.  o  Credit card:  Print order and fax or mail. 

Name on Credit Card _____________________  Card number:_________________________

Exp. Date:  ___/___  Security Code ______  Signature  _______________________________

Item

Description

Color

Price

S&H

Cost + S&H

 Quantity Cost

 1

 Tie

 blue

$75

 8

$83

    

 1

 Tie

yellow 

$75

$8

$83

 

 

 2

 Mug

 

$16

$12.50

$28.50

 

 

 3

 Apron

 

$32.50

$10

$42.50 

 

 

 4

Tote

 

$35

$11

$46

 

 

 5

Pin

 

$5

$2

$7

 

 

 6

Gold Charm

 

$350

$15

$365

 

 

 7

Silver Charm

 

$150

$15

$165

 

 

 8

Enamel Charm

 

$100

$15

$115

 

 

 

 

 

 

 

 

    

 

 

    

 

 

Total

 $

CONFIRMATION

o  Check box if you want email confirmation of receipt of and shipping of your order,

and please provide email address:    _______________________________.