ORDER REQUEST FORM

Name:____________________________________________________________

Email: __________________________________________

Phone: __________________________________________

Shipping Address: ____________________________________________________

_________________________________________________________________

Where did you hear about us? _________________________________________

ITEMS

Item # Item Name Size Color Qty Price Ea Total
_____ . . . . . .
_____ . . . . . .
_____ . . . . . .
_____ . . . . . .
_____ ____________________ ____ _____ _________ ___________ ______
ITEM TOTAL ______
Shipping ______
AK, HI, PR Shipping + 3.00
Express 2 Day + 8.99
Express Overnight + 14.99
SUBTOTAL ______
AL, NC 7% Tax ______
AMT DUE ______


PAYMENT ENCLOSED

____ Check or money order for $ ___________ USD. Please do not staple.

____ Bill my credit card:__________________________ exp date: ____ cvv: ___

Billing address (if different from above)

______________________________________________

I authorize 365 Inc. to process payment as described above for my order. If shipping outside the United States, I agree to pay customs fees as required by my local government.

Signature (required) _____________________________________ Date ________

Check and Credit Card Orders Payable to 365 Inc.: Mail orders to "Mail Order, 431 Us Hwy 70-A East, Hillsborough, NC 27278-9334"
Credit Card Orders Only: Fax order to 1-800-950-1994.

United States Shipping Costs
Order Total Standard Ground Two Day Air Next Day Afternoon
$0-$10 $4.99 $13.98 $19.98
$10-$25 $5.99 $14.98 $20.98
$25-$50 $7.99 $16.98 $22.98
$50-$100 $8.99 $17.98 $23.98
$100-$150 $9.99 $18.98 $24.98
$150-$200 $10.99 $19.98 $25.98
$200-$250 $11.99 $20.98 $26.98
Over $250 By Weight By Weight By Weight


International Shipping Costs
Please select International Shipping if shipping outside the United States. In addition to the shipping costs estimated below, the recipient is responsible for all customs fees icluding duties, taxes, brokerage fees, and any other fees assessed at the border before delivery.

International Shipping Zones
  • Zone 1: Canada
  • Zone 2: Europe, Australia, New Zealand, Japan, Caribbean, and Bermuda
  • Zone 3: Central America, South America, Hong Kong, Singapore, Taiwan, and all other countries

    Zone 1 Zone 2 Zone 3
    Order Total Canada Europe & Pacific Asia & All Others
    $0-$150 $20.00 $35.00 $45.00
    $150-$300 $40.00 $55.00 $55.00
    $300-$450 $60.00 $75.00 $75.00
    $450-$600 $80.00 $95.00 $85.00
    $600-$750 $100.00 $125.00 $115.00
    $750-$1000 $120.00 $150.00 $125.00
    Over $1000 By Weight By Weight By Weight


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    Copyright 2010  [365 Incorporated]. All rights reserved.
    Effective: March 16, 2010