Order Form for The Paper Chase Cup®
U.S. Patent No. 5,690,583

Print Form and Mail or Fax to: Paper Chase Productions,  Post Office Box 448, Middleburg, VA 20118
Fax: 540-687-3364  Phone: 540-687-3345 

Phone:                                                            

Price

The Paper Chase Cup® $9.50 ea. (Qty. Less than 50)

The Paper Chase Cup® $8.50 ea. (Qty. 50-99)

The Paper Chase Cup® $7.75 ea. (Qty. 100+)

Convert-a-Cup Shallow Cup Insert $6.50 ea.

Quantity

                      Cups   X  $9.50                           

                      Cups   X  $8.50                           

                      Cups   X  $7.75                           

                     Inserts X $6.50                            

Sales Tax - VA Res. add 5%                                 

Shipping Rates (UPS Ground) -- Cups are shipped with a maximum of 42 cups per box.  For orders of more than 42 cups, calculate the additional shipping charges from the corresponding quantities below.  (Example:  60 cups shipped east of Colorado would be $46 -- 42 cups @ $29 + 18 cups @ $17)

East of Colorado       Colorado and West

up to 6 cups $11        up to 6 cups  $16
7 - 12 cups    $14        7 - 12 cups     $20
13 - 18 cups  $17        13 - 18 cups  $24
19 - 24 cups  $19        19 - 24 cups   $30
25 - 36 cups  $27        25 - 36 cups   $37
37 - 42 cups  $29        37 - 42 cups   $41
 

                Total Charges                              

                     Check or Money Order enclosed, Made payable to "Paper Chase Productions"

                     Visa                             Master Card

Credit Card #                                                          

Exp. Date                                                                  

Signature