ORDER FORM
SEND TO ADDRESS BELOW
ROBERTS SALES AND SERVICE
378 Boistfort Rd.
Chehalis WA 98532
(360)245-3429 OR FAX 360-245-3954
 
Payment Information:

FILL THIS OUT ONLINE THEN PRINT
For Credit Cards, Money Orders or Checks
Your Name
Phone
 
Address
City,  State & Zip Code
Your: E-Mail address to keep you informed 
SHIPPING TO ANOTHER ADDRESS
 
Ship to Name 
Phone
Address 
City, State and Zip Code 
Ship to:  E-Mail address to keep them  formed 
INSTRUCTIONS OR COMMENTS
 
PAYMENT OPTIONS 
Credit Card, Check or Money order  
IF USING CREDIT CARD 
FOR CARD NUMBER DO NOT SPACE OR USE - BETWEEN NUMBERS 
 USE  2222333355556666
Card Holders Name   
Card 
Card Number     exp. date  
 
    1. STOCK NO.    1. QUAINT.    1. PRICE $
  2. STOCK NO   2. QUAINT.    2. PRICE $
  3. STOCK NO    3. QUAINT.    3. PRICE $
  4. STOCK NO   4. QUAINT.    4. PRICE $
  5. STOCK NO.   5. QUAINT.    5. PRICE $
  6. STOCK NO
   6. QUAINT. .
  6. PRICE $
  7. STOCK NO   7. QUAINT.    7. PRICE $
 
   For Washington sales tax only - 
Washington Residents please add 8.9% sales tax for  items shipped to items shipped to 

  
SHIPPING CHARGE 
                     TOTAL 
  THE PRICES BELOW ARE FOR SHIPPING BETWEEN 1 LB. TO 8 LB.
Up to $50.00
$8.75
$50.01 to $100.00
$9.75
$100.01 to 200.00

$14.75
200.01 to 300.00
$16.75
For each $100.00 over $300.01 add $5.50



TO PRINT THIS FORM HIT YOUR PRINT BUTTON
PLEASE ALLOW TWO TO FOUR WEEKS FOR DELIVERY
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