LadyRidersWear--Riding Wear and Accessories for Women, Order Form

LadyRidersWear Order Form

Name
Phone	Evening
Fax	E-mail
Bike Year & Make	Bike Model

	Ship To Address business or residential street address	Billing Address (if different from Ship To Address)
Street
PO Box
City
State
Zip
Country

Qty.	Item #	Brief Description	Size	Price Per Item	Total Cost




				Subtotal
				Sales Tax (VA Residents add 4.5%
				S & H (see below)
				TOTAL

Check, payable to LadyRidersWear
Visa Mastercard American Express
Card Number
Expiration Date

Signature __________________________________

S & H Charges:
$00.01- 15.00=$4.50 $15.01- 50.00=$5.50
$50.01- 75.00=$6.50 $75.01-100.00=$7.50
Over $100, call for rates
S & H for T'Funny Jewelry Only:
$4.50 per item plus $2.00 insurance

Mail form, using check or money order, to:
LadyRidersWear, PO Box 366, Springfield, VA 22150

Fax form, using credit card, to:
703-541-5164 or call 888-857-7989