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Print out this form, complete it, and mail it to the address shown above along with a check or money order for the amount of the order (US Currency ONLY) made out to: Jackson Lures Unlimited Or FAX Credit Card Orders to the phone number at the top of the form.
Name:_______________________________________________ (Please Print)
Address:_____________________________________________ (Please Print)
City:____________________________ State/Prov.:____ Zip:________
Phone:(_____) ________________ Email:______________________________
For Credit Card Orders Include: (Visa & MasterCard ONLY)
Card Number: ________________________________________________________ Expiration (Month/Year): ____/_____
Signature: ___________________________________________________
| Item Description | Length | Color | Qty. | Price (Ea.) | Total |
| $ | $ | ||||
| $ | $ | ||||
| $ | $ | ||||
| $ | $ | ||||
| $ | $ | ||||
| $ | $ |
| Sub-Total: | |
| *Shipping & Handling (See Below): | |
| 5% Sales Tax (Iowa Residents Only): | |
| Order Total: |
Attention:
International Shipping Fees Will Be Calculated Per Shipment.
*Shipping & Handling Fees Within The United States.
| The base cost for shipping & handling is $7.00 up to an order value of $60.00. After that, the shipping and handling charge is: | |
$60.01 - $125.00 = $8.00 |
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P.O. Box 942 -
Marshalltown, IA 50158