Melonious

Melonious® Merchandise Order Form

26 Southpointe Drive

Charleston, WV 25314

304-744-1691 fax: 304 744-1479

Melonious ®

Billing Address		Mailing Address if different from Billing Address
Name:		Name:
Address:		Address:

City, State Zip		City, State Zip
FAX:		FAX:
Phone:		Phone:

SHIPPING AND PAYMENT

Merchandise will be shipped via Ground UPS, with an estimated delivery time of 5-11 business days from the
time the order is shipped. Call for large orders or special shipping arrangements. No tax will be added,

since we are a non-profit organization.

o Check: Print order and mail with check. o Credit card: Print order and fax or mail.

Name on Credit Card _____________________ Card number:_________________________

Exp. Date: ___/___ Security Code ______ Signature _______________________________

Item#	Description	Color	Price	S&H	Cost + S&H	Quantity	Cost
1	Notecards		$12	$2.50	$14.50
2	Mug		$16	$12.50	$28.50
3	Apron		$32.50	$10	$42.50
4	Tote		$35	$11	$46
5	Pin		$5	$2	$7
6	Gold Charm		$350	$15	$365
7	Silver Charm		$175	$15	$165
8	Enamel Charm		$125	$15	$115
9	Tie	blue	$75	$8	$83
9	Tie	yellow	$75	$8	$83
						Total	$

CONFIRMATION

o Check box if you want email confirmation of receipt of and shipping of your order,

and please provide email address: _______________________________.