ThirstyStone Coaster Order Form

 

Price                  Quantity                              Total Cost  

 

Set of four (4) “Silent Messenger” coasters:  $20.00 set              ______x ($20.00)   =   __________

Shipping & Handling*:                                   $5.95 1st set           ______x  ($5.95)    =   __________

$2.50 ea. add. set  _______x ($2.50)   =   __________

(holders only  available with purchase of coasters)

Black Wrought Iron Coaster Holder:             $5.00 ea.             _______x ($5.00)    =    ___________

Oak Circular Coaster Holder:                        $5.00 ea.             _______x ($5.00)    =    ___________

 

     Total: ____________

 

*S & H charges apply to domestic shipping only. Please e-mail ctilghman@cox.net for shipping outside contiguous 48 states.

------------------------------------------------------------------------------------------------------------------------

 

Billing Information                                                       Shipping Information (leave blank if same)

 

Name: ______________________________             Name: ______________________________

Address: ____________________________              Address: ____________________________

___________________________________              ___________________________________

City: _______________________________              City: ________________________________

State/Province: _______________________              State/Province: _______________________

Country: ____________________________              Country: ____________________________

Zip/Postal Code: ______________________  Zip/Postal Code: ______________________

-----------------------------------------------------------------------------------------------------------------------

Credit card Information                    

Type of card (check one):    Visa_____                        MasterCard_____                    Discover_____

 

Name (as it appears on card): ______________________________________________________

Card Number: __________________________________________________________________

Expiration Date (MM / YYYY): ____________________________________________________

Cardholder Signature: ____________________________________________________________

------------------------------------------------------------------------------------------------------------------------

Notes: __________________________________________________________________________ ________________________________________________________________________________

 

Orders may faxed to: (520) 760-2463

For questions or information regarding large orders, please contact Sabbar Shrine or call:

 Carmine Tilghman (520) 760-8885        or                   Bill Tilghman (520) 444-9372

             ctilghman@cox.net                                              wet3prowler@yahoo.com