Dollar Cross Order Form

Print out this form and send it with payment to DOLLAR CROSS ORDERS, 1123 Pine St. ZANESVILLE OHIO 43701.

DATE_____________ SHIP TO:

NAME:_______________________________________________________

STREET ADDRESS:_____________________________________________

CITY___________________________STATE_________ZIP____________

PHONE___________________________

EMAIL ADDRESS:__to receive special coupons and discounts._____________________________________________

ORDER INFORMATION:

Quantity___ Item No________Descript________________________Price_______

Quantity___ Item No________Descript________________________Price_______

Quantity___ Item No________Descript________________________Price_______

Quantity___ Item No________Descript________________________Price_______

Quantity___ Item No________Descript________________________Price_______

Quantity___ Item No________Descript________________________Price_______

Sub Total__________________

Sales Tax ( Ohio Residents Only) 7%__________

Shipping and Handling_____________see table on below

Order Total $___________

Check enclosed___ Money Order enclosed___ credit card visa___ mastercard___ Amex___ Discover____ Card number___________ exp. date ____-_______. name on card_________________

For all U.S. instock orders ground method you will receive your order in 3 to 10 business days. We accept Visa, MasterCard, American Express, Discover and Check or Money Order. If you want to order with a check or money order, just click on the order form link, print out the form and send it in with your payment. If you are not completely satisfied. We will give you a fast courteous refund or exchange within 30 days of your purchase less shipping charges. Only Ohio residents pay 7% sales tax.

Shipping Rates:

(0 to 25.00=$6.99), (25.01 to 50.00=$8.99), (50.01 to 75.00=$10.99), (75.01 to 100.00=$11.99), (100.01 to 125.00=$12.99), (125.01 to 150.00=$15.99), (150.01 to 200.00=$17.99), over $200 is 10% of your order.

ALL OUT OF COUNTRY ORDERS NOTE: YOUR SHIPPING CHARGES ARE ADDED LATER AFTER WE PACK AND WEIGH IT, YOUR RATE IS USUALLY $8 MORE THAN USA ORDERS TO COVER INSURANCE, CUSTOM FORMS, AND MAILING THEM

Make Payable To Christian Dollar Store LLC Thank you for your order and God Bless You.