Vanberia Order Form

P.O. Box 229, 217 West Water Street, Decorah, Iowa 52101 (563) 382-4892 FAX (563) 382-4057

Ordered By
Name_____________________________________________________
Address___________________________________________________
City______________State_____________Zip_____________________
Day Phone_________________________(in case we need to clarify questions on your order)

Send To
Name____________________________________________________
Address___________________________________________________
City______________State_____________Zip_____________________

Please enclose a gift card signed: ____________________________

Up to $25.00	$6.75
$25.01 to $50.00	$7.75
$50.01 to $75.00	$8.75
$75.01 and over	$9.75

Gifts sent to different addresses require separate shipping charges to each.
All shipments in continental U.S. are sent via UPS. Shipping charges will vary for other carriers.
For Hawaii, Alaska, Canada, and RUSH deliveries, please call for charges.
Shipments over 20 lbs. and/or multiple boxes to one location will be billed actual charges.

If requested, items over $5.00 gift wrapped at no charge. (Please specify occasion.)

Method of Payment

Visa MasterCard American Express Discover I've enclosed a check for $________
Exp. Date Account Number Signature __________________________
(Credit Cards will not be billed until merchandise is shipped.)

Thank you for your order. May we add a friend to our mailing list? Just send us their name and address.

Qty.	Item #	Page #	Description	Color/Size	Price Each	Total










Merchandise Total
Sales Tax
Sub Total
Shipping Charges
ORDER TOTAL