Printable Order Form

Print and complete this form. Then MAIL it to:

Language Quest
309 N Mt Shasta Blvd
Mt Shasta, CA 96067 USA


BILLING ADDRESS:
 
Name___________________________________________________________________
 
Address_________________________________________________________________
 
City _______________________State _______ Zip _________ Country _______
 
Daytime Phone ____________________ FAX number _____________________________
 
E-Mail Address _____________________________

Payment: We accept Visa, MasterCard and American Express
 
Credit Card Number __________________________________________________________
 
Expiration Date ______________________________________________________________
 
Name as it appears on Card __________________________________________________
 
Signature of Card Owner _____________________________________________________
 
ITEMS ORDERED:
 
Item #1 ______________________________________ Price $_________
 
Item #2 ______________________________________ Price $_________
 
Item #3 ______________________________________ Price $_________
 
Item #4 ______________________________________ Price $_________
 
Item #5 ______________________________________ Price $_________
 
Item #6 ______________________________________ Price $_________
 
 
Subtotal: $_________
 
California Sales Tax (California deliveries only) @ 0.0775 (7.75%) $_________
 
Shipping & Handling (»Shipping Info): $_________
 
TOTAL Charged to your credit card or check amount $_________