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ADDRESS:______________________________________ CITY:____________________STATE:________________ZIP:__________________ |
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| Item Number | Description--- (Write item numbers for Single State Bears Wanted) | Price | Quanity | TOTAL | ||||
| #CC-0287 | "1999"Full Year Set of 5 Quarter Bears:2011 special price drop | $45.00@set | ______ | ______ | ||||
| #CC-_____ | "1999" Single Bear: write-in____________________price drop | $9.25@each | ______ | ______ | ||||
| #CC-0288 | "2000"Full Year Set of 5 Quarter Bears | $40.00@set | ______ | ______ | ||||
| #CC-_____ | "2000" Single Bear: write-in__________________________ | $8.50@each | ______ | ______ | ||||
| #CC-0289 | "2001" Full Year Set of 5 Quarter Bears | $35.50@set | ______ | ______ | ||||
| #CC-0299 | "2002" Full Year Set of 5 Quarter Bears | $35.00@set | ______ | ______ | ||||
| #CC-0300 | "2003" Full Year Set of 5 Quarter Bears | $35.00@set | ______ | ______ | ||||
| #CC-0311 | "2004" Full Year Set of 5 Quarter Bears | $35.00@set | ______ | ______ | ||||
| #CC-0322 | "2005" Full Year Set of 5 Quarter Bears | $35.50@set | ______ | ______ | ||||
| #CC-1066 | "2006" Full Year Set of 5 Quarter Bears | $35.00@set | ______ | ______ | ||||
| #CC-1072 | "2007" Full Year Set of 5 Quarter Bears | $35.00@set | ______ | ______ | ||||
| #CC-1078 | "2008" Full Year Set of 5 Quarter Bears | $35.00@set | ______ | ______ | ||||
| #CC-______ | Single Bear Write-in, 2001-2008: Year_________State____________ | $7.50@each | ______ | ______ | ||||
| #CC-______ | Single Bear:Write-in, 2001-2008: Year_________State____________ | $7.50@each | ______ | ______ | ||||
| #CC-0859 | Sacagawea Golden Dollar Bear w/dollar coin | $10.50@each | ______ | ______ | ||||
| #CC-1064 | Clark Commemorative Nickel Bear w/nickel coin | $8.00@each | ______ | ______ | ||||
| #CC-1065 | Lewis Commemorative Nickel Bear w/nickel coin | $8.00@each | ______ | ______ | ||||
| #CC-1096 | New Buffalo Nickel Bear (Timeless Toys) | $8.00@each | ______ | ______ | ||||
| Sub-Total:_______________ | ||||||||
| 2011 Special, take 10% off sub-total for all orders:_______________ | ||||||||
| N.J Residents Only: add 7% sales tax on all N.J orders _______________ | ||||||||
| SHIPPING & HANDLING: see below LEFT _______________ | ||||||||
| Note: Shipping out of U.S.A. Add EXTRA Canada $15.00, Over Seas $50.00______________ | ||||||||
| TOTAL INCLOSED_____________ | ||||||||
| On-line:E-mail us your order, add up items & postage, make Credit Card payment to our Pay-Pal account: webmaster@diskworks.com | ||||||||
| U.S. FUNDS ONLY: ( _ ) Cash - - ( _ ) Check - - ( _ ) Money Order--( _ ) Pay-Pal Payment: webmaster@diskworks.com | ||||||||
| Credit Card Type:(VISA, AM or MC)?_____________ Card umber# ______________-___________-___________-___________ | ||||||||
| Exp. Date: _______/_________ - Sceurity Code:_____________ | ||||||||
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NAME:_________________________________ E-Mail: ___________@___________________