flying geese
Gifts, home decor, wall clocks, wedding gifts, acrostic love poems, webmaster resources, non-profit fundraising, family freebies and wholesale distributor program

Retail Customer Order Form
Ship to:  (Enter Billing Address below if different)
  Phone Number: (_____)_____-_________
  Email Address:__________________________________________
  Affiliate ID:_____________________________________________
Fax/Phone/Mail Order to:
  7853 Gunn Hwy #180
  Tampa FL 33626

Code Product Attributes Quantity Price Each Total
Billing Address if Different/Special Instructions/Promo Gift Selection  Merchandise Total
Sales Tax (FL only)
Shipping (see Shipping Chart below)
Coupon Code (if any)                              
Gift Certificate Key (if any)                                
Amount Due

Shipping Chart
Order AmountShipping Charge
Under $29.99$8.95
$30.00 to $39.99$9.95
$40.00 to $59.99$10.95
$60.00 to $79.99$11.95
$80.00 to $99.99$12.95
$100.00 to $124.99$13.95
$125.00 to $149.99$16.95
$150.00 to $199.99$18.95
Over $20010%
This covers normal ground shipping within the continental US. If you have other shipping requirements, contact us.

Payment Information
Credit Card
    Master Card     Visa
    Discover          America Express

    Card Number:_____________________________

    Expiration Date: ___/____/_____

    Signature: _______________________________