JessWakefield.com - Merchandise Order Form

Merchandise Order Form

Ship to:

First Name	:
Last Name	:
Address	:

Citry / Town	:
State / Prov.	:
Zip / Postal	:
Country	:
Phone #	:
E-Mail	:


Item #	Description	Quantity	Price	TOTAL










Shipping	USPS Priority		GRAND TOTAL
Taxes	CT Sales Tax 6%

Shipping costs: $5.95 for 1-3 items; $8.95 for 4-6 items, $11.95 for 7+ items.
To order, print this page, fill in the quantity you want for each item, add shipping & taxes, then calculate the total.

Make check payable to Daren Copeland and send to:

Daren Copeland
125 Fairlawn Ave.
Waterbury, CT 06705