Roxie's Shop
Order Form
(Please print the form first and then fill it out.)
Date: 
YES, I want the following product(s)
Quantity
Color
Price

Total: 

Unique Gift #1-Photo Album, please specify which one and how many.

Unique Gift #2-Combo Tote Bag, please specify which color and how many.

Unique Gift #3-Diaper Baby Cake, please specify baby boy, girl, or boy/girl cake and how many tiers.

Unique Gift #4-Puppy Training Pad Cakes, please specify dog's breed and how many tiers

Unique Gift #5-Ecommerce Website Building System (free bonus will be added).

 First Name:
 Last Name:
 Address:
 City:
 Country:
 E-mail address:
 Day phone:  
Area code Phone number
 Evening phone:  
Area code Phone number
 Card:
 Card Number:
 Expiration Date:
 Shipping Method:

In order to purchase Roxie's Shop product(s), I hereby authorize Roxie's Shop
to bill my credit card, and I agree to pay to my credit card company the
following amount: $ 

Shipping Policies

We offer the following shipping methods and delivery times:

Standard:

United States Postal Service, FedEx Ground 5 - 7 days

Express:

FedEx Three Day

Overnite:

UPS, FedEx, or USPS Next Day Air

Shipping Charges

 Order Value 

Shipping Charges

  Standard 

  Express 

  Overnite 

below $50.00 

$3.95 

$12.00 

$28.00 

from $50.00 to 149.99 

$7.95 

$15.00 

$31.00 

$150.00 and more  

$15.95 

$23.00 

$33.50 


 

We will give shipping charges to you via e-mail for shipment outside of the United States and request your approval prior to shipment.

Credit Cards Accepted

Please note that we accept Visa, MasterCard, Discover Card, & American Express.

Please review our Shipping & Handling charges and include them in the total above.
I understand that my credit card company will convert this amount to the currency of my own country at prevailing market rates.

Credit card authorization:

Signature

------------------------------------------

I understand that I am completely protected by your Money Back Guarantee. If I am not 100% completely satisfied, I will return the product to Roxie's Shop for full refund of the purchase price, no questions asked!

Agreed:

Signature
Fax this form toll free to 866-674-4606
OR
Mail or courier this form to:

Roxie's Shop
P.O. BOX 131628
STATEN ISLAND, NY 10313

Copyright 2004 RoxiesShop.com, All rights reserved Worldwide.