Name Date
Address
City State Zip
Quantity | Description | Unit Price | Amount |
---|---|---|---|
(a) | a | $ | $ |
(b) | b | $ | $ |
(c) | c | $ | $ |
(d) | d | $ | $ |
(e) | e | $ | $ |
(f) | f | $ | $ |
(g) | g | $ | $ |
One to six items | Shipping and Handling $4.95 | $ | |
Seven to twelve items | Shipping and Handling $14.95 | $ | |
SUBTOTAL | $ | ||
Nebraska residents, please add correct SALES TAX |
$ | ||
TOTAL | $ |