Order Form


		Rosalyn Smith Designs, Inc. 673 Poindexter Road - Brighton, TN 38011 voice 901-476-3584 / fax 901-475-4499
	Ordered by:

Name

Address Apt #

City State Zip

Phone: Day Night


	Ship to: (Only if different than "Ordered by") Most orders ship UPS and require a physical address. If total order is for 1 or 2 license plates only, shipping is 4.95 and will be sent priority mail and requires a mailing address.

Name

Address Apt #

City State Zip

Phone: Day

Item No.	Item Description	Color	Size	Qty	Price	Total


	If more space is needed, please print an additional copy.

Merchandise SUBTOTAL
TAX: Add 9.25% of subtotal (for TN sales tax) only if delivered inside Tennessee. Shipping is not taxable.
Shipping & Handling. (see shipping chart)
TOTAL

Method of Payment:
MasterCard Visa American Express Check Money Order

Credit Card No.______________________________________ Exp: __________ Security Code: ______
Name as it appears on credit card:____________________________________________________

Billing address for credit card (Only if different from "ordered by")
_______________________________________________________________________________