ORDER FORM

Laura's Specialty Gift Center
430 W 21st Street Upland PA 19015
(610)447-0594 www.lspgc.com

ORDER FORM

If you are taking advantage of our “Buy 3—Get The Fourth One FREE” offer, be certain to include the Item Number of the free gift on this order form, and under the Total Amount put N/C (No Charge). Free Item must be priced equally to your lowest purchased item.

Please Print Order Form and Send To Address or Email: custserv2@lspgc.com

Send Your Gift To A Friend:

Name: ____________________________________________

Name: _____________________________________________

Street: ____________________________________________

Street: _____________________________________________

City: _________________ State: ________ Zip: __________

City: _________________ State: ________ Zip: ___________

Phone: ____________________________________________

Phone: ____________________________________________

ITEM #

Description

Size

Type/Color

Quantity

Price Ea.

Total

Shipping & Handling

These charges represent only a part of the actual costs. If your order is:

up to $14.99. . . . . . . . . . . . . . . . . . . . . . . . . . . . . add $4.05

from $15.00 to $19.99 . . . . . . . . . . . . . . . . . . . . . .add $4.35

from $20.00 to $24.99 . . . . . . . . . . . . . . . . . . . . . .add $4.65

from $25.00 to $29.99 . . . . . . . . . . . . . . . . . . . . . .add $5.45

from $30.00 to $34.99 . . . . . . . . . . . . . . . . . . . . . .add $6.05

from $35.00 to $39.99 . . . . . . . . . . . . . . . . . . . . . .add $7.80

from $40.00 to $49.99 . . . . . . . . . . . . . . . . . . . . . .add $8.60

over $50.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . add $9.10

1.

Merchandise Total

$

2.

Add Sales Tax (PA only 6 %)

$

3.

Add Shipping Fee (see Chart)

$

4.

Grand Total Amount

$

PLEASE DO NOT SEND CASH
If your Remittance or Credit is Insufficient to PREPAY your order and or Freight, we will automatically ship C.O.D. for Balance Due.

PAYMENT OPTIONS

Make Checks or Money Orders Payable to : Laura's Specialty Gift Center

Personal Check* Money Order Certified Check
Charge my order amount $ __________ to:

MasterCard
Visa Discover Card AMEX

*LSPGC reserves the right to delay shipping up to 30 days pending clearance of personal checks.

Card No.: ______________________________________
Exp. Date: ______________________________________
Cardholder Signature: X____________________________

(Your Signature is REQUIRED to avoid any delays in processing your order)
Please double-check your Credit Card information! Make sure the numbers and date are correct. Incorrect information will delay processing of your order. A $2.50 surcharge is applied to all orders under $25.00

Name: ____________________________________________	Name: _____________________________________________
Street: ____________________________________________	Street: _____________________________________________
City: _________________ State: ________ Zip: __________	City: _________________ State: ________ Zip: ___________
Phone: ____________________________________________	Phone: ____________________________________________

ITEM #	Description	Size	Type/Color	Quantity	Price Ea.	Total

Shipping & Handling These charges represent only a part of the actual costs. If your order is: up to $14.99. . . . . . . . . . . . . . . . . . . . . . . . . . . . . add $4.05 from $15.00 to $19.99 . . . . . . . . . . . . . . . . . . . . . .add $4.35 from $20.00 to $24.99 . . . . . . . . . . . . . . . . . . . . . .add $4.65 from $25.00 to $29.99 . . . . . . . . . . . . . . . . . . . . . .add $5.45 from $30.00 to $34.99 . . . . . . . . . . . . . . . . . . . . . .add $6.05 from $35.00 to $39.99 . . . . . . . . . . . . . . . . . . . . . .add $7.80 from $40.00 to $49.99 . . . . . . . . . . . . . . . . . . . . . .add $8.60 over $50.00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . add $9.10	1.	Merchandise Total	$
	2.	Add Sales Tax (PA only 6 %)	$
	3.	Add Shipping Fee (see Chart)	$
	4.	Grand Total Amount	$
	PLEASE DO NOT SEND CASH If your Remittance or Credit is Insufficient to PREPAY your order and or Freight, we will automatically ship C.O.D. for Balance Due.

PAYMENT OPTIONS
Make Checks or Money Orders Payable to : Laura's Specialty Gift Center
Personal Check*	Money Order	Certified Check	Charge my order amount $ __________ to:
			MasterCard	Visa	Discover Card	AMEX
*LSPGC reserves the right to delay shipping up to 30 days pending clearance of personal checks.			Card No.: ______________________________________ Exp. Date: ______________________________________ Cardholder Signature: X____________________________ (Your Signature is REQUIRED to avoid any delays in processing your order) Please double-check your Credit Card information! Make sure the numbers and date are correct. Incorrect information will delay processing of your order. A $2.50 surcharge is applied to all orders under $25.00