| Mariposa Herbs & Gifts 123 Bridge St., Las Vegas, NM 87701 (505)454-9240 dale@mariposaherbs.com |
[ ] Payment Enclosed (personal check,money order) Amount: $________ (see Grand Total Due) |
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| Name: Mailing Address: Delivery Address: Day Phone: ( ) |
Credit Card Number: Expires: Mo._______ Yr._______ Signature: |
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| Item Name | Quantity | Price | Total |
|---|---|---|---|
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
| $ | $ | ||
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| $ | $ | ||
| $ | $ | ||
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| $ | $ | ||
| Shipping and Handling Charges: Up to $15.00.......$3.00 $15.01–$40.00....$5.00 $40.01–$60.00....$7.50 $60.01–$100.00...$9.00 Over $100.00...$9.00 |
Sub Total | $ | |
| Shipping & Handling | $ | ||
| Grand Total Due | $ | ||