PRINT THIS PAGE AND USE IT AS YOUR MAIL ORDER FORM FOR GLASS FANTASY

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Item #

Description

Color

Size

Quantity

Price Each

Total
             
             
             
             
             
             
             
             

Shipping Charges (insurance included):

US "Lower 48" States Subtotal over $99: FREE SHIPPING!
US "Lower 48" States: UPS Ground..... $8.95
US "Lower 48" States: Priority Mail..... $8.95
US "Lower 48" States: Express Mail..... $24.95
US "Lower 48" States: UPS Next Day Air..... $54.95
US "Lower 48" States: UPS 2nd Day Air..... $21.95
US "Lower 48" States: UPS 3 Day Select..... $17.95
AK, HI, Military, US Territories: Priority Mail..... $10.95
Canada: UPS Standard..... $14.95
Canada: USPS Global Express..... $24.95
International: USPS Global Express..... $34.95

Subtotal:

  

Sales Tax 5.5% WI Only:

  

Subtotal:

  

Shipping & Handling:

  

Total Amount Enclosed:

  

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PLEASE ALLOW 2-4 WEEKS FOR DELIVERY

 IF YOU HAVE PURCHASED ADULT EROTICA:

THESE ITEMS ARE INTENDED FOR ADULTS ONLY 18 YEARS OF AGE OR OLDER. BY SIGNING BELOW YOU ARE MAKING THE FOLLOWING STATEMENT. I AM OVER 18 YRS OF AGE AND IT IS LEGAL FOR ME TO PURCHASE ADULT EROTICA IN MY CITY, STATE, COUNTRY, TERRITORY OR PROVINCE.

I HAVE READ AND AGREE WITH ABOVE STATEMENT

SIGNATURE: ____________________________________

DATE OF BIRTH: ____________