Ruby & Begonia : Order Form

Ruby & Begonia
ORDER FORM

Please print this order form using your browser's print option.

Name:__________________________________________________________________________

Address:___________________________________________________________________________________

City:_______________________________________

State:_________________

Zip:__________

Phone:_______________

Fax:____________________

Email:_________________________________________

Credit Card #:___________________________________________

Expiration Date:___________________

MasterCard

Visa

Signature:________________________________________________________________

Item	Description	Retail Cost	Quantity	Total

Shipping & Handling charges for Warehouse Sale and accessories only.

U.S. ONLY
Shipping & Handling
Under $20.00 = $4.95
$20.01 - $30.00 = $5.95
$30.01 - $50.00 = $6.95
$50.01 - $75.00 = $7.95
$75.01 - $100 = $8.95
Over $100 = $9.95

CANADA & INTERNATIONAL
Payment by Visa or M/C Only*. Shipping & Handling will be added to the merchandise total.

*If you wish to pay by check or money order, shipping information may be requested via e-mail only at info@rubyandbegonia.com

Subtotal
UT residents add 7.75% tax
Shipping & Handling
Total

Please make checks payable to:
Chapelle, Ltd.
215 Historic 25th Street Ogden, UT 84401
Ph: 801.621.2777 • Fax: 801.394.2825
Please allow 2 to 4 weeks for delivery

In the event we are sold out of one or more of your selected items, we will contact you to offer a substitution.

Fill out the hard copy and fax or mail it to us along with your check or credit card information.
We will process your order in a timely and efficient manner.