Circle D Western

For Information call (616) 299-7817

Order Form

 

 

Name: _______________________________Phone: (____)_____________________

 

Address: _____________________________________________________________

 

City: ________________ State: _______ Zip: _________ e-mail: ________________

 

Method of Payment: ______ Check _____ Money Order

 

Item Name / Description

Qty

Price

Total

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

Order Total:

$

Michigan Residents Add 6% Sales Tax:

$

Shipping and Handling Charge:

$

$ 0.00 to $20.00        add $5.95 US            $25.95 International

$20.01 to $35.00       add $6.95 US            $25.95 International

$35.01 to $50.00       add $7.95 US            $25.95 International

$50.01 to $74.99       add $8.95 US            $25.95 International

$75.00 up                  Free US shipping        $25.95 International

Total:

$

 

Print this order form, fill-in the information and mail it w/check or money order to:

Circle D Western

5371 Coit Ave NE

Grand Rapids, MI  49525