LIGHTHOUSE MERCHANDISING CORP.

ORDER FORM 

Fill in & Print the Following Form to Place an Order We do except credit card orders, visit our online store. Make money orders payable to: LightHouse Merchandising Corp.  Mail To: Light House Merchandising Corp. 162 Henry Street,   Hempstead N.Y. 11550                       Allow 4 to 6 weeks for delivery.

Quantity Item Number Description Size Second Choice Price Each Total Quantity Item Number Description Size Second Choice Price Each Total Quantity Item Number Description Size Second Choice Price Each Total Quantity Item Number Description Size Second Choice Price Each Total Quantity Item Number Description Size Second Choice Price Each Total           Subtotal           8.25 sales tax (NY Residents)           XXLG size +$3.00 each         See Chart Below Shipping Charges           Total

Delivery Information: Name: Address 1: City: State: Zip Code: Country: Voice Phone: Fax: Email:

Domestic Shipping Charges (see chart below) Overseas shipping add 25% of total order Allow 4-6 weeks delivery Make check or money order payable to LightHouse Merchandising corp.  U.S. Funds only     Merchandise Total Shipping Up to $20.00 $ 5.00 $20.01 to $40.00 $ 6.25 $40.01 to $60.00 $ 7.75 $60.01 to $80.00 $ 9.75 $80.01 to $100.00 $ 12.00 $100.01 to $150.00 $ 14.00 $150.01 to $200.00 $ 16.00 $200.01 to $250.00 $ 18.00