Poker John's
Las Vegas Discount Package Order Form
|
Please print this form, fill it in and mail with total payment to: John F. Wiley
II, Realtor Acceptable forms of payment: U.S. Money Order, Bank Check or Cashier's Check All Payments to be in US Dollars No personal checks! |
|
|
First
Name
|
|
|
Last
Name
|
|
|
Street
Address
|
|
|
Apt.
Number
|
|
|
City
|
|
|
Zip
/ Postal Code
|
|
|
State
/ Provence
|
|
|
Country
|
|
|
Email
Address (so that we can confirm shipment)
|
|
Order and Shipping
|
The package weighs 3 lbs, Shipping is per package Shipping &
handling & postage $5.50 for 2-day Priority Mail |
||
|
Number
|
Extension
|
|
| Packages @ $7.77 ea | ||
| Priority Shipping (U.S.)@ $5.50 | ||
| Global Airmail (Can.) @ $8.00 | ||
| Global Airmail (Other) @ $10.00 | ||
|
Total
|
||
Thank You For Your Order!
Shipment will be made within 1 business day of receipt of your order and will be confirmed by email within 12 hours of shipment.