Print and Mail Completed Form To: Bell Book & Candle 337 Sixth Street Carlstadt, New Jersey 07072

Item #	Description	Price	Color/Size	Quanity	Total Amount
.	.	.	.	.	.
.	.	.	.	.	.
.	.	.	.	.	.
.	.	.	.	.	.
.	.	.	.	.	.
.	.	.	.	.	.
.	.	.	.	Merchandise Total	.
.	.	.	.	Add Shipping	.
.	.	.	.	Total Amount	.

Ship To: Name: _________________________________________ Street Address: ________________________Apt.#_____ City: __________________________________________ State & Zip: ____________________________________ The Following Is Not Necessary, But Helpful If There Is A Problem Filling Your Order: Telephone (____) ________________________ E-Mail ________________________________ Š Yes Please Add Me To Your Customer Mailing List Š No Thanks, I Prefer To Be Kept Off Mailing List

Make Check Or Money Order Only Payable To BELL BOOK & CANDLE  Do Not Send Cash   For Credit Card or PayPal Please Order On-Line

Shipping Cost Calculations

$0.01 - $9.99 . . . . . $4.75   $10.00 - $49.99 . . . . . $6.75     $50.00 - $99.99 . . . . .  $8.75                        $100.00 - Or Over -  Free Shipping Freight Charges Apply Only Within The Continential United States. Orders Outside Of The US May Incur Additional Charges