Order Form

DATE: _______________                                                                                     
NAME: _________________________________________________________
ADDRESS: ______________________________________________________
CITY, STATE, ZIP ________________________________________________
PHONE(S): ______________________________________________________
EMAIL: ________________________________________________________
QTY              ITEM/NAME                                                                         PRICE  
______   _______________________________________________   _________
______   _______________________________________________   _________
______   _______________________________________________   _________
                                                                                   Subtotal     _________
                                                       Tax (6.25% MA residents only)    _________
                                                                                  *Shipping    _________
                                                                                         Total    _________

*Shipping Charges will be USPS Priority Mail, Insured, with Delivery Confirmation unless you prefer UPS or FedEx. The
rate will be calculated using the actual weight and distance + insurance for the full value + delivery confirmation + $1.50
for handling. Shipping outside the continental US will follow international rates.
Please contact me by email (bears@raspbearies.net) or phone
(508-779-0909) to verify availability, discuss any special requests and
calculate shipping before sending this form
Payment Method:  Circle one
Mastercard     Visa     Discover     Paypal**     Check or Money order***   

Credit Card #___________________________________ Exp Date____/____
Billing address for card used if it is different from the shipping address:
**I will email or phone you the address to deposit funds to my Paypal account
*** Check or money order made payable to either 'Vicki Stephan' or 'Raspbearies'
Please mail completed form (with check or money order, if chosen) to:
Vicki Stephan      44 Andrews Dr.     Uxbridge, MA 01569
Thank you!