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                                                   DAKOTA CROSSROADS

                                                                Order Form

                                                       Please send a check or money order to:                                        

Visa and Mastercard also accepted                                                       Dakota Crossroads      

through  Paypal                                                                                        P.O. Box 2081

                                                                                                                     Jamestown, ND  58402

                                                                                                                     ( Ph. 701-252-6474)  Make payments with PayPal - it's fast, free and secure!

                                            ITEM          Qty.           PRICE

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Name:

[   Total of              ]

   Merchandise

 [                            ]
Street:

[ ND Residents      ] Add 5% Sales tax

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City:                                                       State:

[  Shipping &        ]

    Handling 

 [                             ]
Zip:                                                         ph. #: [    TOTAL   ]  

Credit Card  No.____________________                              Shipping & Handling charges      

Exp. Date  _____________________                     Order Amount               Standard Express 

 

Name  (as it _________________________________ 

 $0   -  - -  $10.00               $3.95  $150.01 - $200.00            $12.95
$10.01  -  $30.00               $4.95 $200.01 - $250.00            $13.95
$30.01  -  $50.00               $6.95 $250.01 - $300.00            $14.95
$50.01  -  $75.00               $7.95  $300.01 - $400.00            $15.95
$75.01  -  $100.00              $9.95  $400.01 - $500.00            $17.95
$100.01 - $125.00             $10.95   over   $500.00             $19.95
$125.01 - $150.00              $11.95

                                                                                               $0   -  - -  $10.00               $3.95                   $150.01 - $200.00            $12.95

 Name  (as it _________________________________         $10.01  -  $30.00               $4.95                   $200.01 - $250.00            $13.95

 appears on card)                                                                      $30.01  -  $50.00               $6.95                   $250.01 - $300.00            $14.95

                                                                                                $50.01  -  $75.00               $7.95                   $300.01 - $400.00            $15.95

Address ______________________________________      $75.01  -  $100.00              $9.95                   $400.01 - $500.00            $17.95

                                                                                              $100.01 - $125.00             $10.95                        over   $500.00             $19.95      City / State ____________                                 $125.01 - $150.00              $11.95

                                                                                                                                                        

  Zip ______________  ph. # ________                                       Back to Dakota Products

     

 

 

 

 

 

 

 

                                                                                                $0   -  - -  $10.00               $3.95                   $150.01 - $200.00            $12.95

 Name  (as it _________________________________         $10.01  -  $30.00               $4.95                   $200.01 - $250.00            $13.95

 appears on card)                                                                      $30.01  -  $50.00               $6.95                   $250.01 - $300.00            $14.95

                                                                                                $50.01  -  $75.00               $7.95                   $300.01 - $400.00            $15.95

Address ______________________________________      $75.01  -  $100.00              $9.95                   $400.01 - $500.00            $17.95

                                                                                              $100.01 - $125.00             $10.95                        over   $500.00             $19.95      City / State ____________                                 $125.01 - $150.00              $11.95                                                        

                                                                                                                                                         

  Zip ______________  ph. # ________                                       Back to Dakota Products