ETC Shop, LLC

Complete Form and Fax or Mail to:
ETC Shop, LLC
PO Box 406
Pedricktown, NJ 08067 
fax: (856) 299-2210 (Please call first)

 

Bill To:

Ship To:

Name:  

Name:  

Address:  

Address:  

City:  

State:  

Zip:  

City:  

State:  

Zip:  

Phone:  

Phone:  

e-mail address (needed for order/shipping confirmation):  

 

Item Description

qty.

price each

total price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

Satisfaction Guaranteed!
If you are not completely satisfied,
return it for a full refund.

Shipping & Handling (see chart below):                    

Order Subtotal:                    

Sales Tax – New Jersey Residents Add 7%:                           

Gift Certificate Number:                                                                 Subtract Gift Cert. Value:                    

Internal Code: Fax or Mail                                                                 Your Order Total Due:                    

 

Shipping Method (check one)       __ U.S.A.       __ International (Please Call for International Shipping Prices)

U.S.A. Order Amount
$0.00 to $14.99 =
$15.00 to $25.99 =
$26.00 to $49.99 =
$50.00 to $74.99 =
$75.00 to $99.99 =
$100.00 to $199.99 =
$200.00 to $499.99 =
$500.00 to 749.99 =
$750.00 to 999.99 =
$1000.00 to 1999.99 =
$2000.00 to 2999.99 =
$3000.00 to 3999.99 =
$4000.00 to 4999.99 =
$5000.00 & up =

U.S.A. Shipping Cost
$6.49
$7.49
$9.49
$11.49
$12.49
$14.49
$17.49
$19.49
$29.49
$59.49
$99.49
$139.49
$179.49
$249.49

 

 

 

 

 

 

 

Payment Method. Sorry, no CODs. (check one)

__Check or Money Order (Payable to ETC Shop)     __Visa     __Mastercard     __Discover

Print Name on Credit Card:  

Credit Card Number:                                                       CID:

Expiration Date:  

Signature:  

Today's date:  

Please Note: Checks must be drawn from U.S. banks.