Customer Information:
Name:
________________________________________________________________
Address:
________________________________________________________________
________________________________________________________________
City: ________________ State: __________ Zip/Postal Code: _____________
Phone: _(____)_________________ Email Address: ____________________
Shipping Information: (skip this section if same as billing address)
Name: __________________________________________________________
Address: ________________________________________________________
________________________________________________________________
City: ________________ State: __________ Zip/Postal Code: _____________
The following information is required.
1. List the paper name you have chosen in Step 1: Choose Your Paper:
________________________________________________________________
2. Complete and submit your completed poetry information request form:
Step 2: Design Your Message ON-LINE ONLY by clicking the SUBMIT button beneath the completed form. NOTE: This is the only part of the order process that you will still be required to send ON-LINE.
3. Order Your Poetry - Tell us the poetry package you want and calculate your cost by placing a checkmark next to your selected poetry package (prices are from our Pricing Information page):
________ 5-6 verses UNFRAMED - $49.95 ($7.00 S&H)
________ 10-12 verses UNFRAMED - $69.95 ($7.00 S&H)
________ 5-6 verses EMAILED - $49.95 (No S&H)
________ 10-12 verses EMAILED - $69.95 (No S&H)
________ 10-12 verses UNFRAMED - $79.95 ($7.00 S&H)
________ 10-12 verses EMAILED - $79.95 (No S&H)
________ 6-12 verses UNFRAMED - $119.95 ($7.00 S&H)
________ 6-12 verses EMAILED - $119.95 (No S&H)
________ 5-6 verses UNFRAMED - $49.95 ($7.00 S&H)
________ 10-12 verses UNFRAMED - $69.95 ($7.00 S&H)
________ 5-6 verses EMAILED - $49.95 (No S&H)
________ 10-12 verses EMAILED - $69.95 (No S&H)
Subtotal: __________________________
Shipping & Handling (from pricing above): ______________________
________ Rush Order - Add $25.00 (available only if paying by credit card or
PayPal) - Order shipped within 3 BUSINESS DAYS
________ Extra copy of poem - Add $10.00 for each extra copy requested
and enter the number of extra copies you want.
TOTAL: $_______________________________
Your Signature: __________________________________________________
Mail Completed Order Form and Mail Personal Check to:
Poetry By Design
9 Dobson Ct
Pakenham, 3810
Australia
Note: Mail orders paid for by check cannot be shipped until check has cleared. There is a $25.00 returned check charge.
If You Prefer to Phone in Your Order: Call 1-888-MY.POETRY (1-888-697-6387) toll free. Remember, please complete Step 2: Design Your Message and send only that portion to us on-line via the Submit button. Otherwise, have this form completed including your credit card information and one of our operators will be happy to take your order.
To return to the site, click Your Browser BACK Button Or Click The Following Link - Poetry By Design Homepage
Poetry By Design
Off-line Order Form
For Phone, Mail Orders
Print and Complete this form
1-888-MY-POETRY
