CAPE ANNIE'S LIGHTHOUSE

ORDER FORM - - - PRINT A COPY, FILL IT OUT and MAIL/FAX IT TO US!

Cape Annie's Lighthouse, 807 Rt 28, South Yarmouth, MA 02664
1-508-398-9790, FAX: 508-398-9791, www.capeannieslighthouses.com, e-mail:capeannieslight@aol.com

SOLD TO:

Name_______________________________________
Address_____________________________________
City_________________State_______Zip__________
Phone Number_________________________

SHIP TO: (If different from SOLD TO:)
Name_______________________________________
Address_____________________________________
City_________________State_______Zip__________
Phone Number_________________________

PAYMENT METHOD: Circle One:

VISA - MASTERCARD - DISCOVER - MONEY ORDER - PERSONAL CHECK**
** PLEASE note that a personal check will delay the shipment of your order until it has cleared.
CREDIT CARD NUMBER __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Exp. Date ___________ 3-Digit Code (on back) ___________ Signature____________________________________________

#	Item Code Number	Quantity	Description (with color/size, if necessary)	Unit Price	Extended Cost
1
2
3
4
5
6

Total Purchases	Shipping Costs
0 - $30.00	Add $7.95
$30.01 - 60.00	Add $8.95
$60.01 - 80.00	Add $9.95
$80.01 - $100.00	Add $10.95
$100.01 - 120.00	Add $11.95
$120.01 - 140.00	Add $12.95
$140.01 - 160.00	Add $13.95
$160.01 - 180.00	Add $14.95
$180.01 - 200.00	Add $15.95
OVER $200	Add $17.95

SUBTOTAL
MA residents, add 5% Sales Tax
Shipping Costs
TOTAL

Shipping Rates are for UPS GROUND
NO P.O. Boxes
Continental U.S. ONLY!
HEAVY items will require EXTRA shipping costs.
If you live outside the 48 states, or need FASTER shipping, please call or e-mail us for details.

GO SHOPPING!

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