Beak Boutique Art by Nancy Kasten 1264 W. 25th St. Upland, CA., 91784 909-982-7929 Email: beakboutique@aol.com

Ordered by ___________________________________________________ Street _______________________________________________________ City__________________________________________________________ State_____________________________ ZIP________________________ Day Phone________________ Email_______________________________

Item #	Description	Quantity	Unit Price	Amount

Shipping & Handling Charges: Orders to $15.00 - $3.00 $15.01 to $20.00 - $3.50 $20.01 to $30.00 - $4.50 $30.01 to $40.00 - $5.50 $40.01 to $50.00 - $6.50 $50.01 to $75.00 - $7.50 $75.01 & UP ----- 10%

Sub Total__________ CA residents only                   Sales tax 7.5%__________ Shipping/Handling__________ TOTAL___________

Payment Information We accept personal checks, money orders and Visa & MC Please complete if billing info is different from above. Cardholder's Name _______________________________________________ Address________________________________________________________ City___________________State__________________ZIP________________ Phone__________________________________________________________ Visa___ MC____ Credit Card Number __________________________________________ Expiration date ________________________