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Kirkwood News Mail Order Form:

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Contact and billing information:

Name:

 

Street Address:

 

Address 2 (if needed)

 

City, State and Zip:

 

Country

 

E-mail:

 

 Phone: [  ] Day or [  ] Evening

  (         )

Shipping Address: [   ] Same as billing address, or:

Name:

 

Street Address:

 

Address 2 (if needed)

 

City, State and Zip:

 

Country

 

E-mail:

 

 Phone: [  ] Day or [  ] Evening

  (         )

Special instructions:



Order information (click here to see an example)

 Product Name and Description

PRICE

QUANTITY

TOTAL

 Prescription Guide To Mexico and Canada  $14.95    
 Prescription Guide To Europe and Canada  $14.95

 

 

 Prescription Guide To Mexico, Europe and Canada  $24.95    

(Standard Shipping and handling for all U.S. 50 states and territories) Add $5.00

5.00

Subtotal

 

For Express USPS shipping  U.S. 50 states and territories (Available only with Money Order) Add $15.00

 

(Shipping and handling for CANADA ONLY) (U.S. funds only) Add $1.00

 

(Standard Air Mail Shipping and handling for all other countries) (U.S. funds only) Add $4.00 

 

(Priority Air Mail Shipping and handling for all other countries) (U.S. funds only) Add $10.00

 
Subtotal

 

TOTAL

 

Please make your check or money order
payable to
Kirkwood News,
Please send check or money order (U.S. funds only) to:

 
Kirkwood News
P.O. Box 5748
Wilmington, DE 19808-0748

Instructions: Please print the above form on your printer. With your mouse
HIGHLIGHT
everything above these instructions. Click the FILE option
in the upper left corner of this screen. Go down the options to PRINT
option and click it. When the new window opens, click the SELECTION
button. Then click the OK Button. When the above form prints out,
fill out form as necessary, refer to the example below if necessary, then
send it along with payment to the above address.


Return to the Order Page

 

SAMPLE

Contact and billing information:

Name:

 John Doe

Street Address:

5555 Oak Street

Address 2 (if needed)

Suite 3B

City, State and Zip:

Mountain Town, NY 10433

Country

USA

E-mail:

 [email protected]

Phone: [ X ] Day or [  ] Evening

   ( 222 ) 222-2222

Shipping Address: [   ] Same as billing address, or:

Name:

 Jane Doe

Street Address:

444 Peach Street

Address 2 (if needed)

 

City, State and Zip:

This Old Town, MD 24455

Country

 USA

E-mail:

  [email protected]

 Phone: [ X ] Day or [  ] Evening

   (  555 ) 555-5555

Special instructions:
 Do not ship Until Monday. I will be back from my business trip then. Thank you.  


Order information

Product Name and Description

PRICE

QUANTITY

TOTAL

 Prescription Guide To Mexico and Canada  $14.95    
 Prescription Guide To Europe and Canada  $14.95

 1

 14.95

 Prescription Guide To Mexico, Europe and Canada  $24.95    

(Standard Shipping and handling for all U.S. 50 states and territories) Add $5.00

 5.00

Subtotal

 19.95

For Express USPS shipping  U.S. 50 states and territories (Available only with Money Order) Add $15.00

 

(Shipping and handling for CANADA ONLY) (U.S. funds only) Add $1.00

 

(Standard Air Mail Shipping and handling for all other countries) (U.S. funds only) Add $4.00 

 

(Priority Air Mail Shipping and handling for all other countries) (U.S. funds only) Add $10.00

 
Subtotal

19.95

TOTAL

19.95

(Back to blank order form)