The Red Lancers - Ordering Form
Directions: Print out this form. For each item you are ordering, fill in a line in Part 1 with the item's information, then fill in the information for lines 11 through 13 and fill in the total amount due below line 13. Check which payment type applies in Part 2, and fill in the information about the payment type. Fill in the address information completely.

LINE
NUMBER

 PART 1

COL "A"

COL "B"

COL "C"
( COL "A" x COL "B" )

MANUFACTURER ITEM NUMBER QUANTITY PRICE LINE SUBTOTAL
1. . . . x .        = $
2. . . . x .        = $
3. . . . x .        = $
4. . . . x .        = $
5. . . . x .        = $
6. . . . x .        = $
7. . . . x .        = $
8. . . . x .        = $
9. . . . x .        = $
10. . . . x .        = $
11.

Subtotal: All amounts in COL "C", Lines 1-10 added together

=

 $
12.

6% Sales Tax (PA residents only): Amount from line 11 multiplied by .06,
all fractions rounded up to nearest cent

=

 $
13.

Shipping and Handling: Based on amount in line 11 if shipping within the U.S, or  verified via contact with us if outside the U.S

 = $

Total Amount Due: Lines 11, 12, 13 added together:

 = $

 

PART 2 - Payment Type (Check One)

VISA

 [ ] CC Number:                                                Exp.Date (MMYY) ;                 

MasterCard

 [ ] CC Number:                                                Exp.Date (MMYY)                  

Personal Check

 [ ] Check Number:                                                                                                 

Money-Order

 [ ] Money Order Number:                                                                                      

Name :                                                                                        
Address:                                                                                    
                                                                                                   
City:                                                                                            
State, Province, Territory:                                                         
Country (if outside the U.S.A):                                                  
Zip Code:                                                                                    
Phone:(      )                                                                                
E-mail Address:                               @                                        

Signature:                                                                                    

Make checks and money orders payable to, and then mail or FAX this form to:

The Red Lancers
14 Broadway
Milton PA, 17847

FAX: (570) 742-4814