The Bass Rosin Store
Houston, Texas ~ USA
Phone: 832.549.2881
Email: bassrosin@gmail.com
On-Line Order Form
PLEASE NOTE LIMITS PER ORDER
1st Class Mail --- Maximum up to 6 cakes
Priority Mail --- Maximum up to 8 cakes
STEP 1: Copy This Complete Form, Paste It Into an Email,
               Then Enter Your Information Onto the Form
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PURCHASER:*
Email Address:*
Day Phone Number:*
NUMBER of CAKES:*
MAILING ADDRESS:
Name:*
Address 1:*
Address 2:*
Address 3:*
City:*
State/Province or N/A*:
Postal Code:*
Country:*
Check if Mailing Address is Correct _____
MAILING/HANDLING: (Check One)
1ST CLASS USPS MAILING -- Limit 6 cakes per order
_____ FREE USPS 1st Class Mail within United States
_____ Add $15.00 for USPS 1st Class Mail to Canada
_____ Add $20.00 for USPS 1st Class International Mail outside USA/Canada
PRIORITY USPS MAILING -- Limit 8 cakes per order
_____ Add $10.00 for USPS Priority Mail within United States
_____ Add $30.00 for USPS Priority Mail to Canada
_____ Add $50.00 for USPS International Priority Mail outside USA/Canada
BALANCE and PAYMENT METHOD:
(1) Number of cakes x $20.00 ........ $ _______
(2) Mailing/Handling Fee ............... $ _______
(3) TOTAL BALANCE ..................$ _______
Payment made with _________
ADDITIONAL MESSAGE:
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STEP 2: Make Payment of Total Balance with either (a) or (b)
(a) To pay within the USA with Zelle, send Balance to 8325492881
(b) To pay with PayPal / Credit or Debit Card / Bank Account:
Click on Personal link, then Send link. Follow instructions to send Total
Balance to johnctucker@sbcglobal.net
Note: Please use Family and Friends, if possible.
STEP 3: After making Payment, Email the Cmpleted Form to bassrosin@gmail.com
               Confirmation of
Order and Payment will be emailed
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*Required Information
See Additional Ordering Information for REFUNDS / RETURNS / EXCHANGES
Additional Ordering Information
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