Mail-In/Fax Order Form
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Print this form out when you have entered the necessary information and send it to the address at the bottom or email it to us at canplast444@yahoo.com
FULL NAME: ___________________________________________
TELEPHONE NUMBER: ______________________________________
SHIPPING ADDRESS: ______________________________________
EMAIL ADDRESS: ______________________________________
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YOUR ORDER:
MARK QUANTITY NEXT TO EACH ITEM:
.5” PAIR OF SHOE INSERTS - ($10.50) ______________
1.00” PAIR OF SHOE INSERTS - ($11.95) ______________
1.25” PAIR OF SHOE INSERTS - ($13.75) ______________
1.50” PAIR OF SHOE INSERTS - ($15.45) ______________
1.75” PAIR OF SHOE INSERTS - ($17.95) ______________
2.00” PAIR OF SHOE INSERTS - ($19.50) ______________
2.25” PAIR OF SHOE INSERTS - ($21.50) ______________
2.50” PAIR OF SHOE INSERTS - ($23.95) ______________
3.00" PAIR OF SHOE INSERTS - ($29.95) ______________
If ordering (4) of each size deducts 18%, if ordering (8) of each size deduct 36% from
the individual pricing.
SAMPLE PACK #1 1”, 1.5”, 2” PAIRS --------------------($29.95) ____________
SAMPLE PACK #2 1”, 1.5”, 2”, 2.5” PAIRS --------------($48.50) ____________
SAMPLE PACK #3 1/2", 1 1/4", 1 3/4" PAIRS ------------($29.50) ____________
SAMPLE PACK #4 1/2", 1 1/4", 1 3/4" and 2 1/4" PAIRS- ($42.75) ____________
SAMPLE PACK #5 2 1/4" and 2 1/2" PAIRS-------------- ($32.50) ____________
SAMPLE PACK #6 2 1/2" and 3" PAIRS-------------------($41.95) ____________
ULTIMATE SAMPLE PACK--------------------------------($89.50) ____________
SHIPPING AND HANDLING:
- REGULAR FIRST-CLASS MAIL ------------------------ (ADD $7.95) ________
- PRIORITY MAIL ------------------------------------------(ADD $12.95) ________
- INTERNATIONAL SHIPPING (REST OF WORLD) ----- (ADD $27.95) ________
NUMBER OF US DOLLARS ENCLOSED---------------- $___________________
CHECK OR MONEY ORDER TOTAL AMOUNT---------$____________________
VISA/MASTERCARD/DISCOVER:
ACCOUNT NUMBER ________________________________________________
THREE DIGIT CODE ____________
EXPIRATION DATE ____________
NAME AND ADDRESS ON ACCOUNT IF DIFFERENT FROM ADDRESS ABOVE
FULL NAME:
______________________________________________________
BILLING ADDRESS:
______________________________________________________
SEND PAYMENT TO:
Canfield Plastics
10670 Lisbon Road
Canfield, OH 44406
Email to: canplast444@yahoo.com