MULBERRIBUSH ORDER FORM (for merchandise found on www.mulberribush.com) SHIP ORDER TO: Name ________________________________ Address ______________________________ _____________________________________ City _________________________________ State _______________ Zip Code _________   METHOD OF PAYMENT: (check one) Check or Money Order Charge: (circle one) VISA MASTERCARD DISCOVER __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Credit card number Expiration Date _____/ _____/ ______ Signature _______________________________________ Daytime Telephone _______________________________ Item # Qty. Description Group Name Size, Color Price Each Total Price                                                                                                                 SHIPPING & HANDLING If Order is: Up to $15 Add: $ 4.95 $15.01 to $25 $ 5.95 $25.01 to $40 $ 6.95 $40.01 to $50 $ 7.95 $50.01 to $75 $ 8.95 $75.01 to $100 $ 9.95 $100.01 to $200 $10.95 Over $200 $12.95 Subtotal   Shipping & Handling   Tax (if applicable)   TOTAL
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