Order Form

Mail orders to:
Tom Yurasits Productions
534 E 5th Street
Northampton, PA 18067 USA
Fax and Voice Order Line:
(610)-262-8633
Type Information Then Print Order Form

First Name: Last Name:
Street Address: City: State:
Postal Code: Country:
Daytime Phone:
E-Mail:

Sub Total PA Residents Please Add 6% Sales Tax Shipping & Handling Domestic Insurance Rates Total Pick a Card, Any Card! Credit Card Information Card Type Please select one Visa Mastercard American Express Discover Card Number Expires Name on Card Comments & Questions

Shipping & Handling Rates $7.50 or under.........= $2.95 S&H $7.51 to $20.00.......= $3.50 S&H $20.01 to $35.00.....= $4.75 S&H $35.00 to $75.00.....= $5.95 S&H $75.00 and up..........= $6.95 S&H $100.00 and up........= $8.25 S&H Foreign orders E-mail for rates. Shipping@TomYurasitsProductions.com

Domestic Insurance Policy Our responsibility ends when shipment leaves our premises. We therefore suggest you insure your order. Insurance fees are as follows: $ 0.01 to $ 50.00......................... $0.75 $ 50.01 to $100.00 ..................... $1.60 $100.01 to $200.00 .................... $2.40 $200.01 to $300.00 .................... $3.50 $300.01 to $400.00 .................... $4.60 $400.01 to $500.00 .................... $5.40 $500.01 to $600.00 .................... $6.20 Maximum Liability.....................$600.00