Order Form

MidPoint Cafe Gift Shop

INSTRUCTIONS: Print out this Order Form. Fill in your complete name, mailing address and daytime phone number in the provided space. Please print legibly! Enter your choices to the form. Add totals for all items. TX residents add 7.75% tax, include shipping charges - see chart below. Please, checks or money orders only in US dollars on a US bank. No wire transfers or foreign currency. Foreign orders please contact the MidPoint Cafe Gift Shop for shipping charges.
Make payment payable to MidPoint Cafe Gift Shop & send to:

NAME:

ADDRESS:

CITY:

STATE: ZIP:

DAYTIME PHONE: ( )

email:

MidPoint Cafe Gift Shop
P.O. Box 144
Adrian, TX 79001

e-mail: info@midpointroute66cafe.com

Orders must be paid in full. Items subject to availability. Prices subject to change without notice.

NUMBER	ITEM DESCRIPTION	SIZE	QTY	PRICE	TOTAL

SHIPPING CHARGES CHART:
ORDER TOTAL:			ADD:	ORDER TOTAL:			ADD:
$ 0	to	$ 9.99	$ 5.00	$ 10.00	to	$ 49.99	$ 8.00
$ 50.00	to	$ 99.99	$ 10.00	$ 100.00	to	$ 199.99	$16.00
$200.00	&	UP	$20.00
Texas Residents Only add 7.75% to Subtotal

SUBTOTAL

TAX
(TX Residents add 7.75%)

SHIPPING
(see chart at left)

ORDER TOTAL

Please allow 4 - 6 weeks for delivery

Special Instructions or Comments: ________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

Thank You for your order!

Click Button to Print Order Form Below:

MidPoint Cafe Gift Shop