NAME: _________________________________________________________________________________
ADDRESS: ______________________________________________________________________________
CITY: ____________________________________________STATE: ________________________________
ZIP, POSTAL CODE: ____________________________COUNTRY_________________________________
E-MAIL ADDRESS: ________________________________________________________________________
MERCHANDISE
QTY
OF: ____________Dr. Chuds Deathguard Flag Pin,
..........................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds Cross Pin,
.............................................................$1.00 each....=
$___________
QTY OF: ____________Dr. Chuds Got Blood Pin, .....................................................$1.00
each....= $___________
QTY OF: ____________Dr.
Chuds X-Ward Logo Pin, ..............................................$1.00 each....=
$___________
QTY OF: ____________Dr.
Chuds Diagnosis For Death Pin,
..................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds Dr.Pumpkin Pin, ..................................................$1.00
each....= $___________
QTY OF: ____________Dr. Chuds Headnurse
Pin,
...................................................$1.00 each....= $___________
QTY OF: _______Dr.Chud 2007 DRUM STICK,.........................................................$10.00
each...= $___________
QTY OF: _______SACRED TRASH CD,......................................................................$10.00
each...= $___________
QTY OF: _______SACRED TRASH CASSETTE,..........................................................$8.00
each..= $___________
QTY& SIZE OF: _________X_________2000 HALLOWEEN T-Shirt,...................$12.00
each..=.$___________
QTY& SIZE OF: _________X_________2002 HALLOWEEN T-Shirt, ..................$12.00
each..= $___________
SHIPPING
AND HANDLING:
USA: (1-2 items) $4.00, (including buttons)
(If ordering more than 2 items, include $1.00 for each additional item ordered
excluding buttons)
Canada: (1-2 items) $5.00, (If ordering more than 2 items,
include $1.50 for each additional item ordered)
Mexico, Brazil & Argentina: (1-2 items) $8.00, (If ordering
more than 2 items, include $1.00 for each additional item ordered)
Australia, New Zealand & Japan: (1-2 items) $13.00, (If
ordering more than 2 items, include $2.00 for each additional item)
UK, Holland, Finland , Sweden, Germany, Austria, Luxembourg, Italy,
Spain, Wales, Poland, France & Denmark:
(1-2 items) $11.00, (over 2 items, include $1.00 for ea. additional item)
If your Country is not listed here E-MAIL us at chudmerch@hotmail.com
TOTAL # OF ITEMS ........................_____________
TOTAL PRICE OF ITEMS...........................................................
= $____________
TOTAL PRICE OF SHIPPING.....................................................
= $____________
GRAND TOTAL ENCLOSED...................................................... =
$____________