If you choose not to make payment using our secure PayPal Shopping Cart, please use this order form.
Print
and Mail Completed Order Form
to:
RoCo Enterprises
P. O. Box 7647
Richmond, Virginia 23231
Fax to (804) 795-7239 or Call: 804-938-6142
Item Number
Description
Quantity
Price Each Total
Be sure to indicate where appropriate
Black/White/Male/Female
____________
____________________________________ _____
$________ $_______
____________
____________________________________ _____
$________ $_______
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____________________________________ _____
$________ $_______
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____________________________________ _____
$________ $_______
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____________________________________ _____
$________ $_______
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____________________________________ _____
$________ $_______
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____________________________________ _____
$________ $_______
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$________ $_______
Sub-Total: $_______
Sales Tax (4.5% - Orders Shipped
to the State of Virginia): $_______
Shipping (If your order sub-total is
$0.01 - 9.99 add $5.50, $10.00 - 49.99 add $7.50,
$50.00 - 99.99 add $9.00, $100.00 -
199.99 add $10.50, $200.00 and over add
$11.75): $_______
TOTAL AMOUNT SUBMITTED/TOTAL AUTHORIZED CHARGE:
$_______
Ship to:
Name: _________________________________________ Phone Number: (_____)
_______________
Street Address: ____________________________ City: ____________
State: ____ Zip: _________
Payment Method: __Ck./M.O. __Credit Card
Card Type: __MasterCard __VISA __Discover
Name On Credit Card: _________________________ Credit Card Number:
_____________________
Card Expiration Date: _________ Signature of Cardholder:
___________________________________
Order Date: _______________________
