MARIPOSA E-MAIL ORDERING FORM

Mariposa Herbs & Gifts
123 Bridge St., Las Vegas, NM 87701
(505)454-9240
dale@mariposaherbs.com Payment Amount:
(see Grand Total Due)

Credit Card C.O.D. (see C.O.D. info)

Visa Mastercard

American Express

Name:
Mailing Address:
Delivery Address (if different from Mailing Address):
Day Phone (begin with area code): Credit Card
Number:

Expires: Mo. Yr.

Name on Card:

Item Name Quantity Price Total

Shipping and Handling Charges:
Up to $10.00.......$3.00 $40.01–$50.00....$5.00
$10.01–$20.00....$3.50 $50.01–$75.00....$5.50
$20.01–$30.00....$4.00 $75.01–$100.00..$6.00
$30.01–$40.00....$4.50 Over $100.00......$7.00
For C.O.D. orders, please add $3.50. Sub Total

Shipping & Handling

C.O.D. Charge

Grand Total Due

Item Name	Quantity	Price	Total


















*Shipping and Handling Charges:* Up to $10.00.......$3.00 $40.01–$50.00....$5.00 $10.01–$20.00....$3.50 $50.01–$75.00....$5.50 $20.01–$30.00....$4.00 $75.01–$100.00..$6.00 $30.01–$40.00....$4.50 Over $100.00......$7.00 For C.O.D. orders, please add $3.50.	Sub Total
	Shipping & Handling
	C.O.D. Charge
	Grand Total Due