Jelsma Graphics - Order Form

Jelsma Graphics Order Form

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This order form is opened in a separate window browser for your convienience in placing an order. You can navagate the site in the original window before you came to the order form and switch back and forth to this order form while filling in your items. Please complete the following form, and press "Submit" at the bottom to submit your order. THIS IS A SECURE CONNECTION! (See locked icon in lower right of your browser) Your order will be securely sent to Jelsma Graphics. If you have any questions about placing your order, please call us at 904-716-0436 or print and mail this order form to:

Jelsma Graphics
2238 Winding Creek Lane
Jacksonville, FL 32246-4136

Description (include size and color)	Item #	RR Logo #		RR Logo on Front	Name on Front	Qty	Item Price	Total $
1.							$	$
2.							$	$
3.							$	$
4.							$	$
5.							$	$
Subtotal								$
RR Logo on front (add $11 per item) - For Jacket Only								$
Name on front (add $10 per item) - For Jacket Only								$
7% Sales Tax (Florida originating addresses)								$
Shipping & Handling 1-3 prints ($7.50) - 4+ prints ($8.95) 1-2 shirts ($8.50) - 3+ shirts add $1.50 each. (4 shirts = $8.50 + $1.50 + $1.50) Jackets ($9.50) - 2+ add $2.50 each (4 Jackets = $9.50 + $2.50 + $2.50 + $2.50) 1-2 brass ($17.00) - 2+ add $3.50 each (4 Brass = $17.00 + $3.50 + $3.50)			International Customers add: Canada + $3.00 Mexico + $8.00 S. America / Puerto Rico + $13.00 Europe + $13.00 Australia / NZ + $13.00 Asia + $13.00 Africa + $15.00					$
Grand Total								$

SHIPPING INFORMATION

Name:

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Company:

Address:

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City:

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State:

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Zip / Postal Code:

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Country:

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E-Mail Address: (Used only in case of questions)

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Phone # (Used only in case of questions): -->Required Field

PAYMENT INFORMATION

Pay by:
Cashier's Check, Certified Check, or Money Order
Personal Check
VISA MasterCard American Express Discover Charge on Account

Card #

Expiration Date

Credit Card Billing (if different than shipping address)

Name:

Address:

City:

State:

Zip / Postal Code:

E-Mail Address:

Phone # (Used only in case of questions):

Please Press "Submit" Only Once
It May Take Up To One Minute To Process Your Order
Thank You for Your Order!