Papyrus Place

Papyrus Place Order Form

Papyrus Place, 401 West Main Street, Suite 1807, Louisville, KY 40202
(502) 896-2901 fax/phone

Billing Address
Name:	_______________________________	Telephone:	________________________
Street:	_______________________________	Fax:	________________________
City:	_______________________________	E-Mail:	________________________
State:	___________ Zip: ________________

Shipping Address (If different than billing address)

Name:

_______________________________

Street:

_______________________________

City:

_______________________________

State:

___________ Zip: _______________

Credit Card:	Mastercard Visa
Exact Name On Card:	________________________
Credit Card Number:	________________________
Expiration Date:	________________________

Item No.	How Many	Description	Price Each	Total Price
__________	__________	_________________________________________	__________	__________
__________	__________	_________________________________________	__________	__________
__________	__________	_________________________________________	__________	__________
__________	__________	_________________________________________	__________	__________
__________	__________	_________________________________________	__________	__________
__________	__________	_________________________________________	__________	__________
__________	__________	_________________________________________	__________	__________

Shipping, Handling, and Insurance

Up to $20.00..........$8.75		$60.01-$90.00........$15.75
$20.01- $40.00..........$10.75		$90.01+........$16.75
$40.01-$60.00..........$13.75		$100+ Call or email for quote

Sub Total	__________
Shipping	__________
KY Residents add 6% sales tax	__________
Amount Enclosed	__________