| FIGURINE ORDER SUMMARY | ||||
| Order Date: - - | ||||
| Figurine Price | $ | |||
| Calif. Sales Tax * | @ | 7.75% | = | $ |
| Shiping & Handling | $ | |||
| Total Order | = | $ | ||
| * California Residents only | ||||
| Date Figurine is needed by: - - | ||||
| Billing Address | |||
| Parent's Name | Home Phone - - | ||
| Address 1 | City | ||
| Address 2 | State | Zip | |
| Cell/Wk Phone - - | |||
| Shipping Address (if different) | |||
| Name | Phone - - | ||
| Address 1 | City | ||
| Address 2 | State | Zip | |
| PAYMENT INFORMATION: | |||||
| Check Enclosed | Please charge my Credit Card | ||||
| CREDIT CARD INFORMATION: | |||||
| Name on Credit Card: | |||||
| First | Middle | Last | |||
| NOTE: Please make sure that the Billing Address (above) is where the credit card statement is sent. | |||||
| Credit Card Type: | Visa | Mastercard | |||
| CREDIT CARD NUMBER: | EXPIRATION DATE | ||||
| Month / Year | |||||
| 3 OR 4 DIGIT SECURITY CODE | |||||
| Signature: _____________________________________________________ | |||||