HOLE IN THE GARDEN WALL FAX AND MAIL ORDER FORM PLEASE PRINT YOUR RESPONSES! Date  ________________________ First and Last Names    _____________________________________________________________________ Street Address             _____________________________________________________________________ City, Zip Code, Country_____________________________________________________________________ E-mail Address            _____________________________________________________________________ Daytime Phone (area code first)   ___________     ____________________ Shipping Address  ___  check here if same as above            Street Address  _____________________________________________________________________            City, Zip, Country ____________________________________________________________________ Credit Card Number     Visa  ______________________________________________________                                    MasterCard _________________________________________________                                    Discover  ___________________________________________________                                    American Express_____________________________________________                                    3-digit security code on back of card to the right in signature strip  ________                                     4-digit code on AMEX card above number at extreme right on front _______                                   Name exactly as it appears on the credit card ________________________ Credit Card Authorization Signature from Card Owner ___________________________________ Check or Money Order: Make payable to KohlQuest ITEMS ORDERED ITEM QUANTITY UNIT PRICE AMOUNT Hole in the Garden Wall Book  _______ 24.95 ___ ______ Sub Total _________ NC delivery add .065 sales tax _________  Shipping & Handling [see below] _________ Second Day Air add $6.00 _________  Next Day Air add $12.00 _________ AK and HI deliveries add $8.00 _________ TOTAL ORDER _________ Shipping ~ Handling Charges $ 29 -   60  .....  add $6.95    61 - 120  .....  add   8.95  121 - 210  .....  add 11.95  211 - 300  .....  add 13.95 orders over $300. call for special rates FAX your completed form to: 828  286  9786 MAIL your completed form with payment to: KohlQuest 3271 Polk county Line Road Rutherfordton, NC 28139

DIRECTIONS:

1.  Print out this order form.  If you don't have a printer, just write all pertinent order information on a plain sheet of paper and mail or fax it with your payment.
2.  Fill in all lines.  Be sure all information you provided is accurate.  Check for any misspellings or typos.
3.  Be sure to include the correct shipping and handling information before entering you final order amount.
4. If you are paying by credit card, please be sure you have submitted the correct card number and expiration date and signed your name on the CREDIT CARD OWNER AUTHORIZATION SIGNATURE line.
5. If you are mailing in your order, please include a check or money order made payable to KohlQuest.  Mail your completed order form with payment to:
                KohlQuest
                3271 Polk County Line Road
                Rutherfordton, NC 28139
6. If you are faxing your order form, fax to:  (828) 286-9786

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