Pagan Presence Text Mail In Order Form

Serving You Since March 1999

Please Complete, Print And Send Form With
Payment Payable To Pagan Presence Inc.
*** U.S. Dollars Only *** To:

    Pagan Presence Inc.
    P. O. Box 803, Medina, OH 44258-0803
    USA

Please Print Clearly	Please Print Clearly	Please Print Clearly
	Specify Your Ring Size When Ordering A Ring.

Customer Bill To Information

Name:

Street Address:

Apartment Number:

City:

State\Provence:

Zip/Postal Code:

Country:

Telephone Number:

E-Mail:

All Orders Are Shipped To The Customer Bill To Address - No Exceptions

Enter Item(s) You Are Ordering Here (Use Additional Forms If Necessary)

Item Number	Description	Size	Qty	Price













			Subtotal
			Shipping
	Ohio Residents Only, 6.50% of Subtotal		Sales Tax
			Order Total

Shipping & Handling Charges

Order Total		Shipping & Handling
Up to $ 29.99		$ 4.50
$30.00 - $59.99		$ 5.00
$60.00 - $89.99		$ 6.00
$90.00 - 119.99		$ 7.00
$120.00 - $149.99		$ 8.00
$150.00 or more		$ 10.00
Overnight Delivery		$50.00 plus normal shipping and handling
International		$ 15.00 plus normal shipping and handling

Personal checks take up to 3 weeks longer to process than money order or credit card. $30.00 fee on all bounced checks.

Method of Payment

[    ]Check	[    ]Money Order	[    ]Mastercard

[    ]Visa	[    ]American Express	[    ]Discover Card

[    ]Other:_______________________________


Card#:_________________________________________________

Exp. Date:______________________________________________

Print Name:_____________________________________________


Signature:______________________________________________

Credit Card Online Payments