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:__________________
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 } 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.
Mail to;
Disk Works of South Jersey
187 Clayton-Aura Road
Glassboro, New Jersey 08028-3404