Midsummer Fairies Order Form

Midsummer Fairies
Toll Free 1-866-44-FAIRY
Fax 1-661-715-1645
4306 West Avenue L
Quartz Hill, California 93536

Name:____________________

Address:___________________
__________________________
City:______________________

State:______________________

Phone:_____________________

Name:____________________

Address:___________________
__________________________
City:______________________

State:______________________

Phone:_____________________

Shipping Address

Billing Address (if different)

Payment Method:

Money Order

Visa

Mastercard

Discover

Item #

Description

Price

Qty

Total

SUBTOTAL

TAX

(CA residents add 9.75%)

SHIPPING

TOTAL

(All Orders Shipped US Mail Or UPS Ground)
$0       -  $19.95 = $8.95
$20.00 - $29.99 = $10.95

$30.00 - $39.99 = $11.95
$50.00 - $59.99 = $12.95
$60.00 - $69.99 = $13.95
$70.00 - $79.99 = $14.95
$80.00 - $89.99 = $15.95
$90.00 - $99.99 = $16.95
$100+ - $17.95


SHIPPING RATES

Credit Card #___________________________

Expiration Date__________

Email_________________________

Name On Credit Card________________Signature___________________

American Express