Personally Puzzled - Mail Order Form (Date:_________________)
P.O. Box 15163 Loves Park, IL 61132-5163
www.personallypuzzled.com E-mail: puzzled1@earthlink.net
Creating Jigsaw Puzzles of your Favorite Photo Memories
Do not send multiple orders using this form. Print and fill out a separate form for each different puzzle.
When you mail your order please include check or money order with your photo and completed order form. Fill out all instructions including e-mail and/or phone number in case I need to contact you with questions concerning your order. Next to personalized copy print any information you would like to appear in your puzzle. Print any special instructions for your puzzle. If your puzzle uses one of the backgrounds available list which one.
PLEASE PRINT
| Name: |
| Address: |
| City, State, Zip: |
| Phone number including area code: |
| E-Mail address: |
| Personalized copy: |
| Special instructions: |
| How did you hear about us: |
SHIPPING CHARGES
(Purchases up to $30.00 add $7.50) ($30.01 to $55.00 add $9.50) ($55.01 and up add $11.50)
| Quantity | Puzzle Selection | Price |
Amount |
| 1 | 10 x 16 (252 piece puzzle) | $24.50 | |
| Duplicates of 10 x 16 puzzle | $16.00 each | ||
| XXXXXX | OR | XXXXXXXXXXX | XXXXXXXXXX |
| 1 | 16 x 20 (504 piece puzzle) | $31.50 | |
| Duplicates of 16 x 20 puzzle | $22.00 each | ||
| Sub Total | |||
| Illinois residents add 8.25% Sales Tax | |||
| Shipping | |||
| Total | |||