 |
| MAIL/FAX ORDER FORM |
Ordered By / Bill To:
Please Note: Payment by credit card must
have information as on card.
|
Please mail or fax order form to the following:
Amy's Hearing Depot, Inc.
PO Box 1281
Deerfield Beach, Fl. 33443
Fax: (954) 425-0658 Phone: (866) 977-HEAR 4327
Email: customerservice@/
|
| Name:
|
________________________ |
| Address:
|
________________________ |
| City:
|
________________________ |
| State/Zip:
|
________________________ |
Ship To: (UPS does not deliver to PO Boxes.)
|
| Day Phone:
|
________________________ |
Name:
|
__________________________
|
| Evening Phone:
|
________________________ |
Address:
|
__________________________
|
| Fax:
|
________________________ |
City:
|
__________________________
|
| Email:
|
________________________ |
State/Zip:
|
__________________________
|
|
|
Phone:
|
__________________________
|
Please Note: Orders will not be processed
until clearance of funds.
|
| Quantity
|
Item #
|
Item Ordered
|
Color/Size (if any)
|
Unit Cost
|
TOTAL
|
| _______
|
__________
|
_______________ |
________________
|
________
|
_______
|
| _______
|
__________
|
_______________ |
________________
|
________
|
_______
|
| _______
|
__________
|
_______________ |
________________
|
________
|
_______
|
Shipping and Handling Charges: |
SUB TOTAL:
|
_______
|
| $00.01 - $50.00 Add $7.00 to total |
FL. Residents add 6.00% sales tax:
|
_______
|
| $50.01 - $100.00 Add $8.75 to total |
| $100.01 - $150.00 Add $9.75 to total |
Shipping and Handling:
|
_______
|
| $150.01 - $250.00 Add $10.50 to total |
| $250.01 - $350.00 Add $13.00 to total |
GRAND TOTAL:
|
_______
|
| $350.01 and over Add $15.00 to total |
These shipping charges apply only to the 48 contiguous United States.
A surplus charge of $15.00 will be added to all items shipped outside the
continental United States. Additional shipping charges may apply to International
addresses.
Domestic orders are usually shipped via UPS ground. Please allow at least 5-7 business days for delivery. |
|
| Payment Method:
|
| ____ Check or money order is enclosed. Payable to Amy's Hearing Depot, Inc.
|
| ____ MasterCard ____ Visa ____ American Express
|
| Card Number: _______ _______ _______ _______ 3 Digit Security
Code (AMEX 4 digits): ____ |
| Expiration Date: ________ ________
|
| Signature required for credit card:________________________________________________
|