TM

Order Form

NAME:________________________________________________
ADDRESS:_____________________________________________
_____________________________________________________
CITY:______________________STATE:_______ZIP:_________
PHONE:(______)_________________________DATE:_________
Payment Method:__Check __Money Order __Visa __MasterCard__Discover__AmEx
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __Expiration Date:_____/______
Authorized Signature:________________________________
ITEM #  Description Quantity Unit Price TOTAL PRICE
____________ _____________________________________ _______ ________ _____________
____________ _____________________________________ _______ ________ _____________
____________ _____________________________________ _______ ________ _____________
____________ _____________________________________ _______ ________ _____________
____________ _____________________________________ _______ ________ _____________
TOTAL _____________
Tennessee Residents add 8.75% tax _____________
Shipping (see below) _____________
Grand Total _____________
All orders to AK, HI, PR, must add 2nd Day Air
Shipping & Handling:
$0 to $40 ADD............$05.75
$41 to $75 ADD..........$08.00
$76 to $150 ADD........$12.00
$151 and up ADD........$17.00
Tiffany Lamps and Brass Ships require no UPS Ground Shipping
*** Canadian Orders Please Double Shipping ***
 *** UPS Next DAY is $65.00 Additional ***
*** UPS 2nd DAY is $45.00 Additional ***
*** UPS 3 Day Select is $25.00 Additional ***
NOTE: All Orders must be made in US Dollars
UPS will not deliver to a P.O. Box
You must be 18 years old to purchase or have a parents signature on
the order form confirming it is OK that you purchase the above items.
Print this form, make checks and money orders payable to and send with payment to:
Imperial Gift LineTM
53 Brentmeade Dr.
Jackson, TN 38305
info@imperialgiftline.com
Phone:
(731) 512-0820
 US Orders Only