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Providence House Order Form


Item Name (Description)/ Quantity of each item/ Price of the item/ Total Amount per Line


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SHIPPING AND HANDLING CHARGES (see chart below) =

TOTAL DUE by CHECK OR MONEY ORDER =


Shipping/Handling charges: up to $19.99=$3.95; $20 - $29.99 = $4.95; $30- $49.99 = $5.95; $50 - $74.99 = $7.95; $75 - $99.99 = $9.95; $100 - $149.99 = $11.95; $150 - $199.99 = $14.95; $200 - $299.99 = $17.95 ; over $300 - 6% of total order

NOTE: Providence House ships UPS only! NO Post Office Boxes!

Please send this form and check or money order to: M.Hernandez,Providence House Distributor, 15581 W. 141 St., Olathe, KS 66062

SHIP ORDER TO: