MakeIceCream.com Ice Cream Maker Dealer
29 Long Branch Ave - Long Branch, NJ 07740 Voice Mail 800-303-0551 - FAX 801-730-3937
Print this form and mail or FAX it to us.
| (A) Ship To: (name and address) | (B) Bill To: (if different from Ship To) |
| Name: _________________________ | Name: _____________________ |
| Address: _______________________ | E-mail: _____________________ |
| Address:_______________________ | Address: ___________________ |
| City:_________ State:___ Zip:______ | Address: ___________________ |
| Telephone:_____________________ | City:________ State:___ Zip:____ |
| Daytime Telephone:____________ |
(C) List of Items:
| Item #: | Item Name: | Quantity: | Price per Item: | Total: |
| _______ | _________________________ | ______ | ___________ | _________ |
| _______ | __________________________ | ______ | ___________ | _________ |
| _______ | _________________________ | ______ | ___________ | _________ |
(D) Totals & Shipping:
| purchase amount: | shipping: | ||
| up to $20.00 | add $4.00 | Merchandise Total:________ | |
| $20.01-$60.00 | add $6.00 | ||
| $60.01-$100.00 | add $8.00 | UPS GROUND Shipping (see chart):________ | |
| $100.01-$150.00 | add $10.00 | UPS can not ship to Post Office Boxes | |
| $150.01-$200.00 | add $12.00 | We are sorry, we can not ship outside the US. | |
| $200.01-$300.00 | add $18.00 | Alaska & Hawaii please call for UPS 2nd Day Air Rates | |
| $300.01-$600.00 | add $22.00 | ||
| over $600.01 | add $30.00 | TOTAL:_______ |
(E) Method of Payment:
___ American Express ___ Mastercard ___ Visa
Credit card #____________________________ &
exp. date:____________