OverStockRetail.com
For Affordable High Quality Products
 MAIL ORDER FORM

PO Box 661448
Bronx, NY 10466

Bill To:                                                                Ship To:

Name: .   Name: .
Address: .   Address: .
City, State ZIP: .   City, State ZIP: .
e-mail:     e-mail:  
Phone: (            )   Phone: (           )
Fax: (            )      

Order:


Item #

Item Description
(include any options, etc.)


Manufacturer


Qty.


Price


Extended

        $ $
           
           
           
           
           
           
           
           
           
Please view the chart below to determine your shipping cost. Freight charges apply within the continental United States. Orders outside the continental United States may incur additional charges.
Sub-Total $
Shipping and Handling $
Total $
These charges represent only a part of the actual costs.We'll pay the rest. If your order is:
Shipping and Handling Chart
up to $24.99..................add $7.50
from $25.00 to $34.99....add $8.45
from $35.00 to $44.99....add $9.45
from $45.00 to $54.99....add $10.45
from $55.00 to $74.99......add $12.45
from $75.00 to $99.99......add $13.95
from $100.00 to $199.00...add $16.95
$200.00 and over.............add $20.95

Payment Info:

 
                                                 

------------------------------------------------ Card Number -------------------------------------------

Exp

Credit Card V-Code:

       

 Card holders should flip your card over. 3 digit number at the end.  This is your V-Code.  American Express card holders will find their V-Code as 4 digits just above the card number.


_______________________________________________
Signature of Cardholder…must match "Bill To" name above.

I authorize OverStockRetail.com to charge the credit card number indicated above for the total above plus sales tax (if applicable). I certify that the credit card number and signature above agree to the "Bill To" name above and that, as such, I am an authorized signer on this card.