Custom Rodbuilders Inc. ORDER FORM

7130 Willis Point Road, Victoria, BC, Date: ______

	Visa	MC	MO
Card #
Expiration Date
Name
Signature

Canada V9E 2A1

Phone toll-free: 1-877-303-9331

Fax: 1-250-544-8893

e-mail: wasnedden@telus.net

Name:
Address:
Town:	State:	ZIP:
Phone:

							EACH
Pg	QTY	ITEM #			DESCRIPTION		LIST	NET	TOTAL
						TOTAL PRICE
Please provide full address (FedEx will not deliver to a P.O. Box)						SHIPPING
Shipping Rates (Blanks 60” and over add $8.00)**						SUBTOTAL
Amt. of order			without blanks	with blanks (max 80”)
Under $50.00			7.50	11.00		TOTAL
50.01 – 100.00			9.50	11.00
100.01 - 250.00			12.50	16.00		Call for shipping rates to Alaska
250.01 – 400.00			14.00	20.50		And Hawaii
400.01 – 750.00			16.00	28.50		Toll-free 1-877-303-9331
Over 750.00			20.00	35.00
						** Lower 48 states only