| Sifu Buck Sam Kong Online Order Form
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Please print this page and clearly fill in all the appropriate spaces.
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Buck Sam Kong
1021 S. Brand Blvd. Suite 102
Glendale, CA 91205 |
Payment Method: |
To pay by credit card,
call, fax or mail in this form. |
To pay by check, mail in this form enclosed with a check. |
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tel / fax: 818.244.8748
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First Name __________________________________________ Last Name ___________________________________ |
Shipping Address __________________________________________________________________________________ |
City ___________________________________________________________ State __________ Zip _______________ |
Ph:______________________________________email:___________________________________________________ |
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Item#:___________ Qty: _____ Descr: _____________________________________ Amount $: ___________ . _______
Item#:___________ Qty: _____ Descr: _____________________________________ Amount $: ___________ . _______
Item#:___________ Qty: _____ Descr: _____________________________________ Amount $: ___________ . _______
Item#:___________ Qty: _____ Descr: _____________________________________ Amount $: ___________ . _______
Item#:___________ Qty: _____ Descr: _____________________________________ Amount $: ___________ . _______
Item#:___________ Qty: _____ Descr: _____________________________________ Amount $: ___________ . _______
Item#:___________ Qty: _____ Descr: _____________________________________ Amount $: ___________ . _______
Shipping & Handling:
Within U.S.
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Add $ 6.50 per item |
| International |
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Add $12.00 per item |
For large quantity order, please call for quotation.
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Sub Total: ___________ . _______
9.75% Calif. Sales Tax: ___________ . _______
Shipping & Handling: ___________ . _______
Total Amount enclosed: ___________ . _______
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