MAIL & FAX ORDER FORM
[Please print this out to use]
Celtic Myth and Moonlight
Celtic Myth & Moonlight, 641 Penn Avenue, West Reading, PA 19611
Phone: (610) 685-2307 Fax: (610) 685-2308
Email: celticmythmoon@aol.com Website: www.celticmythmoon.com
ORDERED BY SHIP TO (IF DIFFERENT)
NAME: NAME:
BILLING/MAILING ADDRESS: SHIPPING ADDRESS:
CITY: CITY:
STATE/PROVINCE: STATE/PROVINCE:
ZIP/MAILING CODE: ZIP/MAILING ADDRESS:
COUNTRY: COUNTRY:
EMAIL ADDRESS: TELEPHONE #:
QUANTITY BRIEF DESCRIPTION SIZE COLOR PRICE EACH TOTAL COST
           
           
           
           
           
May we add you to our email list to receive our monthly newsletter? YES ____ / NO ____ SUB-TOTAL:  
NOTE: Any coupons MUST be included with your order: LESS ANY DISCOUNT:  
Sales within Pennsylvania are taxable, except for herbs, clothing or food items: 6% SALES TAX [PA ONLY]:  
NOT ALL MERCHANDISE SHOWN ON OUR WEBSITE WILL ALWAYS BE IN STOCK. IF WE'RE OUT OF AN ITEM YOU'VE ORDERED WE'LL EMAIL YOU. SHIPPING & HANDLING :  
TOTAL:  
METHOD OF PAYMENT   STANDARD SHIPPING AND HANDLING COSTS (U.S. DOLLARS)
  Personal Check ORDER TOTALS U.S.A. CANADA INTERNATIONAL* WORLD-WIDE*
  Money Order $0.01 to $25.00 $7.95 $9.94 $21.86 $39.75
  Visa $25.01 to $50.00 $9.95 $12.44 $27.36 $49.75
  Master Card $50.00 to $100.00 $13.95 $17.44 $38.36 $69.75
  Discover Card $100.01 to $200.00 $16.95 $21.19 $46.61 $84.75
  American Express OVER $200.00 $25.95 $32.44 $71.36 $129.75
* "International" S&H is for Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Isle of Man, Italy, Mexico, Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom. If you're unsure, please contact us before placing your order."World-Wide" is for the rest of the world.
                               
CREDIT CARD NUMBER
Month: Year:  
Expiration Date Security Code
   
CARDHOLDER'S SIGNATURE DATE SIGNED