Rushburn Toffee Order Form

Print this page, complete, and fax to 415-647-7902. If you need help call 415-647-7902

	FAX TO:	415-647-7902
Please type or print.	PHONE:	415-647-7902

Billing Name:
Billing Company:
Billing Address:
		Daytime Phone:
City:	State:	Evening Phone:
Country:	Zip:	Fax:
Payment Method:  __Visa  __MasterCard  __American Express  __Debit Card  __Money Order __Check* *$20 fee on returned checks
Credit Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date: Mo:__ __ /Yr:__ __		Total Amount: $________
Signature:_____________________________________

Prices subject to change without notice.

Name & Address		English Toffee		Espresso Toffee		Chocolate Clusters
Send to:		Quantity	Price	Quantity	Price	Quantity	Price
Street Address:		___ 1 lb Gift Tin ___ 1/2 lb Gift Tin ___ 1 lb Box ___ 1/2 lb Box ___ 3oz Box	$24.50 $16.00 $17.00 $8.50 $4.00	___ 1 lb Gift Tin ___ 1/2 lb Gift Tin ___ 1 lb Box ___ 1/2 lb Box ___ 3oz Box	$25.00 $16.25 $17.25 $9.00 $4.00	___ 5oz Milk Box ___ 3oz Dark Box	$8.50 $8.75
City:	State:	Method of Shipping: ____________ Cost of Shipping: $________ Total Cost: $________
Phone*:	Zip:
Gift Message: (20 word max.)

*Required for expedited shipping.

Name & Address		English Toffee		Espresso Toffee		Chocolate Clusters
Send to:		Quantity	Price	Quantity	Price	Quantity	Price
Street Address:		___ 1 lb Gift Tin ___ 1/2 lb Gift Tin ___ 1 lb Box ___ 1/2 lb Box ___ 3oz Box	$24.50 $16.00 $17.00 $8.50 $4.00	___ 1 lb Gift Tin ___ 1/2 lb Gift Tin ___ 1 lb Box ___ 1/2 lb Box ___ 3oz Box	$25.00 $16.25 $17.25 $9.00 $4.00	___ 5oz Milk Box ___ 3oz Dark Box	$8.50 $8.75
City:	State:	Method of Shipping: ____________ Cost of Shipping: $________ Total Cost: $________
Phone*:	Zip:
Gift Message: (20 word max.)

*Required for expedited shipping.

Name & Address		English Toffee		Espresso Toffee		Chocolate Clusters
Send to:		Quantity	Price	Quantity	Price	Quantity	Price
Street Address:		___ 1 lb Gift Tin ___ 1/2 lb Gift Tin ___ 1 lb Box ___ 1/2 lb Box ___ 3oz Box	$24.50 $16.00 $17.00 $8.50 $4.00	___ 1 lb Gift Tin ___ 1/2 lb Gift Tin ___ 1 lb Box ___ 1/2 lb Box ___ 3oz Box	$25.00 $16.25 $17.25 $9.00 $4.00	___ 5oz Milk Box ___ 3oz Dark Box	$8.50 $8.75
City:	State:	Method of Shipping: ____________ Cost of Shipping: $________ Total Cost: $________
Phone*:	Zip:
Gift Message: (20 word max.)

*Required for expedited shipping.

Shipping Options and Costs

Merchandise Total	Standard Shipping	Express Delivery	Overnight
Up to $19.99	$5.75	$11.00	$20.00
$20-$34.99	$6.50	$12.00	$21.00
$35-$44.99	$7.50	$14.00	$22.00
$45-$54.99	$8.50	$15.00	$23.00
$55-$74.99	$9.50	$17.00	$25.00
$75-$89.99	$10.50	$19.00	$27.00
$90-$119.99	$12.50	$21.00	$29.00
$120-$249.99	$15.50	$23.00	$31.00
$250-$499.99	$18.50	$27.00	$33.00
$500 and over	8% of net merchandise	12% of net merchandise	15% of net merchandise