Printable Order Form for Polymer Clay Push Molds
Simply Print this form, fill out appropiately and mail to the address below.
Questions? Please email at Lgallegos2@Charter.net
Mold #
Description
Quanity
Mold
Price
Total
Price
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
SUB-TOTAL
SHIPPING
INSURANCE
 (Optional)
FINAL TOTAL
Please Send Check or Money
 Order Payable To:

Luann Gallegos
P.O. Box 80
Sharon, Wi. 53585
Name:________________________________ Email:______________________

Ship To Address:  ____________________________________
                        ____________________________________
                        ____________________________________
U.S. Shipping Fees

If your Sub-Total is:

  0.01 -   4.99  shipping total is $1.85        
  5.00 -   9.99  shipping total is $2.85        
 10.00 - 29.99  shipping total is $3.85        
 30.00 - 49.99  shipping total is $4.50
 50.00 and Up  shipping total is $5.75
If you would like insurance (optional) Please add $1.30 to your total for orders up to 50.00 or $2.20 for orders up to 100.00.