Order Form

Order Form

(To use this form, print this page, fill out info, include check, mail to address below.)

SHIP TO:

NAME _______________________________________________________

ADDRESS____________________________________________________

CITY ________________________STATE _________ ZIP_____________

PHONE ________________________ E-MAIL ______________________

ORDER DATE _______________

LSM PART # | DESCRIPTION | QUANTITY | PRICE EACH | SUB TOTAL

____________|_______________|____________|_____________|____________

SUB TOTAL | ___________

CAL. STATE TAX 7.75% (if applicable) | ___________

SHIPPING* | ___________

OUTSIDE NORTH AMERICA ADD $15.00 SHIPPING | ___________

CHECK OR MONEY ORDER IN THE AMOUNT OF | ___________

CHECK INCLUDED PAYABLE TO THE ORDER OF:

LINDEN SWISS MINIATURES

34711 LYN AVENUE

HEMET, CA 92545

(951) 926-4148 LinSwisMin@adelphia.net

NOTES: __________________________________________________________

__________________________________________________________________

*SHIPPING: 0 - $50.00 = $5.00; $50.01 - 75.00 = $6.00; $75.01 - 100.00 = $7.00; $100.01 OR MORE = $8.00