Isdera Corp. Mail Order Form

Isdera Corporation
510 East 10 Mile Rd. - Hazel Park, MI 48030 | Ph: 1-800-809-0610
Print this form and use it for reference when calling in your order or mail or FAX it to us.

(A) Sold To: (Your name and address)

Name: ____________________________________

Street Address:

____________________________________

____________________________________

City:_____________ State:___ Zip:________

Phone:_______________________

(B) Ship To: (if different from sold to)

Name: ____________________________________

Street Address: ____________________________________

____________________________________

City:_____________ State:___ Zip:________

Phone:_______________________

(C) Items Requested:

Item #:
Item Name: Quantity:
Price per Item:
Total:

___________________ ______________________ ________ ___________ _________

___________________ ______________________ ________ ___________ _________

___________________ ______________________ ________ ___________ _________

___________________ ______________________ ________ ___________ _________

(D) Totals, Taxes, Shipping:

Merchandise Total:________
Michigan Residents: add 6% Sales Tax on merch. delivered in Michigan:________
Shipping (see chart below)
purchase amount:	Domestic (Ground) shipping:	International
up to $20.00	add $4.00	Sorry,
$20.01-$40.00	add $5.00	We are only
$40.01-$60.00	add $6.00	able to accept
$60.01-$80.00	add $7.00	International
$80.01-$100.00	add $8.00	orders over
$100.01-$150.00	add $10.00	the Internet.
$150.01-$200.00	add $12.00
over $200	add $15.00
TOTAL:_______
Note these shipping prices may be slightly higher than the online prices due to increased processing. We apologize the we only offer one shipping method for mail / fax orders. Online orders can also choose: Priority Mail, Express, and International Air Mail.

(E) Method of Payment (we cannot accept personal checks):

___Money order (payable to "Isdera Corp.")
___ American Express ___ Mastercard ___ Visa ___Discover

Credit card #____________________________ & exp. date:____________

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Item #:	Item Name:	Quantity:	Price per Item:	Total:
___________________	______________________	________	___________	_________
___________________	______________________	________	___________	_________
___________________	______________________	________	___________	_________
___________________	______________________	________	___________	_________