Ordering Instructions:
1. Please use multiple copies of this
form if you have more than one color of switch plate cover in a particular style.
2. Print and complete both
pages of the order form by hand or
copy the form into a text editor and complete it then print it
3. Enclose a check made out to Jennifer Adair for the total or provide the requested credit
card information (MasterCard or VISA only).
4. Send your order to:
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Jennifer Adair
270 Brazzell Road
Dickson, TN 37055 |
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Gradient Switch Plate Cover |
Iridizing: |
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Silver to multicolor |
Glass: |
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Dark |
Size: |
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Single |
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Double |
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Triple |
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Quad |
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Dots Switch Plate Cover |
Iridizing: |
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Multicolor |
Glass: |
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Black |
Size: |
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Single |
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Double |
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Triple |
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Quad |
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Craftsman Switch Plate Cover |
Iridizing: |
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Multicolor |
Glass: |
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Black |
Size: |
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Single |
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Kelly Green |
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Double |
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Triple |
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Quad |
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Topography Switch Plate Cover |
Iridizing: |
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Multicolor |
Glass: |
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Black |
Size: |
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Single |
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Kelly Green |
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Double |
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Red |
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Triple |
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Quad |
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Order Total |
Item |
Quantity |
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Price |
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Extension |
Single Toggle |
_______ |
x |
$29.00 |
= |
_________ |
Double Toggle |
_______ |
x |
$49.00 |
= |
_________ |
Triple Toggle |
_______ |
x |
$69.00 |
= |
_________ |
Quad Toggle |
_______ |
x |
$89.00 |
= |
_________ |
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Switch Plate Subtotal |
_________ |
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10% Shipping and Handling for
Switch Plates |
_________ |
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Switch Plate Total |
_________ |
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Book: Wire Wrapped
Angels |
_______ (1 or 2 copies) |
x |
$21.95 |
= |
_________ |
Book: Wire Wrapped
Angels |
_______ (3 to 9 copies) |
x |
$19.32 |
= |
_________ |
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Book Subtotal |
_________ |
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Shipping for First Book: $4.00 |
_________ |
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Shipping for Additional Books:
______ (qty.) x $2.00 = |
_________ |
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Book Total |
_________ |
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Grand
Total |
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Payment Information |
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Name |
_____________________________________ |
Phone (Day) |
___________________ |
Phone (Evening) |
___________________ |
Shipping Address |
___________________________________________________________ |
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___________________________________________________________ |
E-Mail |
_____________________________________ |
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