| Please fill the following Order & Shipping information form. |  |
| Calculate total amount (product + freight) add sales taxes only if in Colorado. | |
| Fax the completed Order & Shipping information form to: |
Juniper
Enterprises Fax
: 1
970 923 6885
1711 Juniper Hill Road
Aspen, CO. 81611 USA
Order & Shipping
information form : Jade
Eggs
* Are required fields
Ship to:
*
Name
___________________________________________________________________
* Shipping Address
___________________________________________________________________
* City
___________________________________________________________________
* Zip code *
State * Country
___________________I__________________I_____________________________
Phone Fax Email
_____________________I__________________I___________________________
Bill to: (If different)
Name
or Company
___________________________________________________________________
Address
___________________________________________________________________
* City
___________________________________________________________________
Zip code State Country
___________________I________________I________________________________
Product :
*
Product name *
Product Price |
||
| * Shipment option please add | ||
| US Ground
$ 7 US 2nd day or Canada standard $ 12 Europe standard $ 25 All other countries $ 29 |
______________ | |
| Tax (Colorado resident please add 6.4 % of the price) |
______________ |
|
| * Total | __________ | |
Credit Card: Visa - MasterCard - American Express
Diners Club Discover
* Credit Card Number *
Expiration date
___________________________________________I___________________________
Comment
:
______________________________________________________________________
Please fax the completed form to 1 970 923 6885
Thanks for your order!
