Fax: (310) 943-2167
(Mastercard/Visa/American Express orders) Card # :___________________________________________________________
Expiration Date and CVV2 #:____________________________________________________________________________
(CVV2 number is a 3- or 4- digit number on the back of the card, right after the credit card number)
(Please circle) Mastercard? Visa? AmEx? Signature:__________________________________________________________
Name as it appears on credit card:_________________________________________________________________________
Phone (required for credit card orders)______________________________________________________________________
To receive adult stamps, please sign below certifying that you are over 21.
Stamps desired: Please write down quantity, item number, description, & price
Price codes- AA:$6.75, A:$7.25, B:$8.00, C:$8.75, D:$9.50, E:$10.25, F:$10.90, G:$13.00, H:$15.50, I:$17.80, J:$19.95, K:$22.95
Unmounted prices - AA: $2.70, A:$3.05, B:$3.50, C:$3.95, D:$4.50, E:$5.00, F:$5.45, G:$6.50, H:$7.75, I:$8.90, J:$9.95, K:$11.40
Additional catalog packs (including Xrubberstamps.com and ASLstamp catalogs and main catalog) are $7.50 each, partial refund ($9.50 outside USA). Xrubberstamps.com catalog is $1.75 each ($3.00 outside USA).
Please (very carefully) add up stamp prices to get the subtotal. _______________________________
California resident? Figure your sales tax here____________________________________________
(either your tax rate or 9.25%, or see ordering info page)
Add shipping here (if you forget, we'll add it for you)_______________________________________
(for U.S. retail orders under $25, shipping is $5.50; $25-50 is $6.95; $50-100 is $8.95; over $100 is $10.95. Other countries are higher -- please see ordering info page. Check/MO orders with insufficient shipping may be delayed.)
Add up for total (please figure very carefully) ____________________________________________
Please make checks/money orders payable to Lost Angeles Rubber Works.
Please allow 4-6 weeks for delivery in the U.S. (but we usually move faster than that!)
Any questions? Please see (you guessed it) the ordering info page or email email@example.com.
Need more space? Just write on the back of this form.