EMMR Racing Video Order Form

EMMR Racing Video Order Form
Print this form, then be sure to give complete descriptions & check your order.
IMPORTANT: Use the table at the bottom of the form to determine your Shipping Charges.
**SHIP TO**
Name:__________________________________________________ Street:__________________________________________________
City: _________________________ State:_______ Zip:__________
Phone:(_______)______________ E-mail:____________________

*Checks & Money Orders Payable To “EMMR”*

Check No._______________ Money Order No._______________

Visa/Master Card No.______________________ Expires_______

QTY.	Description	$ Each	$ Total









	Sub Total
	SALES TAX 6% [PA Residents Only]
	SHIPPING CHARGES [See Below]
	TOTAL REMITTED

MAIL ORDERS TO: Deb Wright, 80 Juniata Pkwy. East, Newport, PA 17074

*Shipping Charges*
Purchase Total	Shipping Charges:
$0.01 to $25.00	Add: $3.95
$25.01 to $50.00	Add: $4.95
$50.01 to $75.00	Add: $5.95
$75.01 to $100.00	Add: $6.95
$100.01 to $125.00	Add: $7.95
$125.01 to $150.00	Add: $8.95
$150.01 and above.	Add: $9.95