DREAMING GATES ORDER FORM *NAME: __________________________________ *STREET: __________________________________ *CITY, STATE ZIP: __________________________________ *COUNTRY: __________________________________ *PHONE: __________________________________ *E-MAIL: __________________________________ *Payment method: __Check __Money Order (all non-U.S. and alternate addresses) __Credit Card / Paypal "echeck" (online orders only) __Other ===================================================================== ITEMS PURCHASED: Qty Name/Description (Code) Price_Each Total_Price . . . . . . . . . . ===================================================================== *SUBTOTAL: _________________ *+SHIPPING: _________________ --> Shipping Rates: ' U.S.: $6 ' Other: inquire +INSURANCE: ________________ --> Insurance Rates (US): ' up to $50 order, $1.30 ' $50-$100 order, $2.20 ' $101-$200 order, $3.20 ' $200+ order, add $1/$100 +OPTIONS: ________________ --> Possible Options: ' Rush order, $5 ' Va. State Tax, 4.5% **TOTAL: _________________ --- Please allow 2-3 weeks for U.S. delivery. $25 fee for all bounced checks - total electronically debited. Packages 5lbs+ may be shipped Parcel Post. NOT RESPONSIBLE FOR GOODS SENT UNINSURED! --- SPECIAL INSTRUCTIONS?____________________________ ================================================================== By sending this order form you agree that you understand and accept our policies and disclaimers. (More info on website.) TO ORDER: Complete form (*=required) and send to... Dreaming Gates * P.O. Box 185 * Lanexa, VA 23089-0185 or fax: (413) 647-4387 * email: order@dreaminggates.com ==================================================================