Golden Trines  Order Form

9 Lleberry Path Palm Coast, Fl. 32164

(386) 386-437-9791

http://www.goldentrines.com

 cat9201@aol.com

Please Print or Type    All orders MUST be pre-paid

Name (as it appears on the card if using a credit card): ______________________________________________

Address: _________________________________ City ______________ State _________ Zip Code ________
Phone No. (____)________________      E-mail Address ____________________
(Readings only)        Date of Birth ________________ Time of Birth ________________
Ship Via:    UPS     US POST OFFICE - no c.o.d.s

Extra charge for overnight

Date: __________________
Quantity Stock # Color Size Item Description Unit Price Total
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Payment Method  Credit Card ___ MO ___ Total of Above Items    

 

  Sales Tax is - 8%    
     
Shipping & Handling    
Order Total    
Check Card type MASTERCARD____ VISA____  EXP. DATE - MONTH _____/ YEAR ____

CHARGE CARD NUMBER

____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____
Three digit # on back near your Signature ______

Billing Statement will indicate Golden Trines

Card Holder's Signature ___________________________________________

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