D.Zine Originals

4715 NW Charles Rd.

Prineville, OR. 97754

..............................................................................................................

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

City,State___________________________________________________________________________

Country, Zip ________________________________________________________________________

Phone: _________________________________ Email: ______________________________________

If shipping to a different address:

Name: _____________________________________________________________________________

Address: ___________________________________________________________________________

City,State___________________________________________________________________________

Country, Zip ________________________________________________________________________

                                                                                                               Total of Order _______________________

  Shipping /Handling Charges:                                                               Shipping ........  + _____________________

                                                                                                               Total Enclosed  $______________________

$0.01 - $9.99    = $   1.50                                                                      (Payable in US Funds ONLY)

$10.00-$49.99  = $   3.00

$50.00-$99.99  = $   7.50

$100.00-199.99= $ 10.00

$200.00- Over = $  12.50

Print and Mail This Order Form to Address Above

(Allow 4-6 weeks for delivery)

[ Home ] [ D.ZINE Products ] [ Search ] [ Mail Order Form ] [ D.ZINE News Page ]

Send mail to dsrtrose@cascade.quik.com with questions or comments about this web site.
Copyright © 2001 D.ZINE ORIGINALS
Last modified: November 26, 2001