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 $35.00 Additional ***
*** UPS 2nd DAY is $20.00 Additional ***
*** UPS 3 Day Select is $10.00 Additional ***
ZINA Scooters can not be shipped by Air.

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 WeaponsTM
53 Brentmeade Dr.
Jackson, TN 38305
imperial@imperialweapons.com

Phone:
(731) 664-5774
(888) 407-0296
US Orders Only
Or, Fax to:
(731) 668-4011