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
Thank you for your order!

                               Return to Order Information page


phone:  828.288.0730   fax:  828.286.9786  email: information@kohlquest.com
All rights reserved © 2005-2006 KohlQuest, Rutherfordton, NC

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