Jelsma Graphics Order Form
READ ME*
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 904-221-3513 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 $9 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:   -->Required Field
Company:
Address:   -->Required Field
City:   -->Required Field
State:   -->Required Field
Zip / Postal Code:   -->Required Field
Country:   -->Required Field
E-Mail Address: (Used only in case of questions)   -->Required Field
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!