HOPS SCRIMSHAW ORDER FORM

Our shopping cart now offers secure on-line ordering. Check out is through PayPal and it is optional to have a PayPal account to check out and a sign-up is no longer required. If you prefer not to use our secure cart method please print out the form below and fax your order to us.

Please be sure to complete all shipping information. If paying by credit card, be sure to fill in all credit card information, and remember to sign and date your order for quick processing. PO Boxes OK - We ship most orders via Priority Mail. HOPS' SCRIMSHAW SHOP 515-967-7966 fax available (call first) PO Box 365 • Mitchellville, Iowa 50169 Email: GoToHops@msn.com

NAME	DAY PHONE
ADDRESS	APT. NO.
CITY	EVE. PHONE
STATE ZIP	COUNTRY
E-MAIL

I authorize HOPS' SCRIMSHAW SHOP to charge my total order to my (please check one): VISA MasterCard

CARD NUMBER

NAME ON CARD EXP. DATE

AUTHORIZED SIGNATURE DATE

QUANTITY	ORDER NO.	DESCRIPTION	PRICE EA.	TOTAL

SHIPPING CHARGES	Merchandise Total
Up to $100 please add $4.50 OVER $100 please add $5.50	IA Residents Add 6% Sales Tax
OPTIONAL INSURANCE CHARGES	Shipping
Up to $50 add $1.30 From $50.01 to $100 add $2.20	Insurance
For each additional $100 add $1	Total Amount of Your Order

Thank you for your order!!!