Heroines Fax/Mail Order Form

Fax to:

763-450-5005

Mail to:

Please include a separate order form for each Ship-To Address.
Fax or mail this form along with your check, money order or credit card information. DO NOT SEND CASH.
You will receive a confirmation e-mail when your order is received and processed.
We ship to all US addresses via USPS First Class Mail.
International Shipping is available, use the 'Special Instructions' below to request a price quote.
Orders ship within 3 business days.

HEROINES by Jila Nikpay

Paperback Edition - $22.00

Number of Sets:

Shipping/Handling:

US Mail $5.00 per set
Canada $7.00 per set
Europe 10.00 per set

Minnesota Sales Tax 7.0%:

($1.54 per set if applicable)

Order Total :

Billing Information		Shipping Information (if different from Billing Information)
Name:		Name:
Address:		Address:
City, State, Zip:		City, State, Zip:
Email:
Phone:

Payment Method
	Money Order	Credit Card Information Card number Card Expiration Date Signature (required for Credit Card Orders): _____________________________________
	Personal Check
	Mastercard
	Visa

Notes or Special Instructions: