JavaScript Order Form

Please note: Due to lack of security on the WWW,
providing the information below is at your own risk!

With the incorporation of JavaScript into the WWW, we are able to help you complete our order form. As you fill out the form below, appropriate calculations will be made. Please take care to check over the form when you are complete, so as to avoid any mistakes. Thank you!


Shipping Address Information

First Name:         Last Name:
Address:
City:       State:         Zip Code:
Day Phone:     Fax:     Country:
E-Mail:
Remarks:


Price Information

Item Code Description Qty Price Item Total
1
2
3
4
5
6
7
8
9
10
Merch. Total

Click if MN resident: Sales Tax
Click for C.O.D.: C.O.D. Charge
Continental U.S.:
Canada, Alaska & Hawaii:
Other:


Pack & Ship
**** Grand Total



Method of Payment

I provide the following information at my own risk:
Visa   Master Card   Discover Card   American Express   C.O.D.
Card Number               Expiration Date
Please call me:
(Give phone number(s) and best times to call for credit card details.)
I will my payment information (credit card or check).

     

Packing and Shipping Prices

Merchandise TotalContinental U.S.Canada, Alaska & Hawaii
less than $25.00$5.00 $6.00
between 25.00 and 50.007.00 9.00
between 50.00 and 100.0010.00 12.00
between 100.00 and 200.0015.0017.00
between 200.00 and 300.0020.0022.00
between 300.00 and 400.0025.0027.00
between 400.00 and 500.0030.0032.00
over $500.0035.00 37.00

*Please note that some finished items have an extra shipping surcharge which needs to be added to the regular shipping charge. Surcharges are listed with the item.


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Last edited on 14-April-1999 by Ben Brown for Musicmaker's Kits, Inc.

Also see exorderzip.htm and exorderziptrial.htm
Copied 05 Jan 2001, modified 06 Jan 01
DOC. @@@:    URL = http://www.multiline.com.au/~johnm/exorderform.htm
Just World Campaign, 46 Cobine Way, Greenwood (a Perth suburb), Western Australia, 6024, Australia. Telephone [+61 8] (08) 9343 9532, Mobile Cellphone 0408 054 319
john.massam@multiline.com.au