 |
 |
 |
||
 |
 |
 |
||
 |
|
|
|
|
||
|
|
|
|
||
|
|
Anne Koplik Designs
173 Main Street
Brewster, New York 10509
(800) 542-3134
|
Items will be sent as pictured. Any requested changes (including changes from fishhooks to leverbacks) will not be processed. We must do this so we can offer these items as such low prices. |
| Style # | Color | Quantity | Unit Price | Amount |
OK to substitute color? ___Yes ____No
OK to substitute similar style and price? ____Yes ____No
If ordering earrings, would you like the earrings on cards? ____Yes ____No
If ordering pins, would you like the pins on cards? ____Yes ____No
Shipping Information
How would you like us to ship your order?
UPS Ground
UPS Second Day Air
UPS Overnight
UPS Ground to Canada
UPS International – Please e-mail for details
ORDERS PROCESSED ON A "FIRST COME FIRST SERVED" BASIS
ORDERS TO BE SHIPPED BETWEEN 1 AND 5 BUSINESS DAYS
Ship Order To:
Name: ________________________________________
Company: ________________________________________
Street Address: ______________________________________
City: ________________________________________
State: ________________________________________
Zip Code: ________________________________________
Business Address OR Home Address
Billing Information
Select the applicable terms for your order.
C.O.D.
Net 30
‘As Before’
Credit Card
Bill Order To:
Check here, if Billing Address is the same as Shipping Address
Company: ________________________________________
Street Address: ________________________________________
City: ________________________________________
State: ________________________________________
Zip Code: ________________________________________
Country: ________________________________________
E-mail Address: ________________________________________
Business Phone: ________________________________________
Alternate Phone: ________________________________________
Tax ID # for
NYS Residents: ________________________________________
Credit Card Information
VISA
Mastercard
American Express
Expiration Date: ________________________________________
3 Digit Code (back of Card): ________________________________________
Name on Card: ________________________________________
Billing Address on Card: ________________________________________
City and State: ________________________________________
________________________________________