Printable 50 State Quarter Bears, Lewis & Clark Nickel Bears & Sacagawea Dollar Bear Order Form: REV. 1/12/2009
- SHIPPING ADDRESS: PLEASE PRINT - E-Mail Address: ____________@____________________
- NAME:_________________________________________
- 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 |
$47.50@set |
______ |
______ |
| #CC-_____ |
"1999" Single State Bear________________________________ |
$10.00@ |
______ |
______ |
| #CC-0288 |
"2000"Full Year Set of 5 Quarter Bears |
$40.00 |
______ |
______ |
| #CC-_____ |
"2000" Single State Bear________________________________ |
$8.50@ |
______ |
______ |
| #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 |
______ |
______ |
|
Write item Number for Single State Bears Wanted |
|
______ |
______ |
| #CC-______ |
Single Bear:Year___________State_____________________ |
$7.50@ |
______ |
______ |
| #CC-______ |
Single Bear:Year___________State_____________________ |
$7.50@ |
|
|
| #CC-______ |
Single Bear:Year___________State_____________________ |
$7.50@ |
______ |
______ |
| #CC-0859 |
Sacagawea Golden Dollar Bear w/dollar coin |
$10.50@ |
______ |
______ |
| #CC-1064 |
Clark Commemorative Nickel Bear w/nickel coin |
$8.00@ |
______ |
______ |
| #CC-1065 |
Lewis Commemorative Nickel Bear w/nickel coin |
$8.00@ |
______ |
______ |
| #CC-1096 |
New Buffalo Nickel Bear (Timeless Toys) |
$8.00@ |
|
|
|
Lowest prices on the Internet, NO DISCOUNTS APPLY |
____SUB- |
TOTAL |
________ |
| New Jersey Residents Only: add 6% sales tax on all N.J orders _______________ |
| SHIPPING & HANDLING ( on all orders see below ) _______________ |
| Note: Shipping out of U.S.A. Add EXTRA Canada $5.00, Over Seas $25.00______________ |
| TOTAL INCLOSED_____________ |
|
U.S. FUNDS ONLY: ( _ ) Cash - - ( _ ) Check - - ( _ ) Money Order--( _ ) Pay-Pal Payment: webmaster@diskworks.com
|
|
SHIPPING & HANDLING {Quarter Bear Orders ONLY }
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Make checks payable to: Disk Works of South Jersey |
- 0 to $9.99 add $3.75
- $10.00 to $19.99 add $4.75
- $20.00 to $39.99 add $6.75
- $40.01 and up add $8.75 - Unused postage will be refunded.
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- Mail to;
- Disk Works of South Jersey
- 187 Clayton-Aura Road
- Glassboro, New Jersey 08028-3404
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