Order Form

Please Print Order Form

Mail or Phone your order to:
RT-DESIGNS USA
P.O.Box 2061, ~ Salisbury, NC 28145-2061
Phone (704) 279-9301
Email = RTDesignsUSA@gmail.com ~~~~~Web = http://www.RobertToth.com    &   https://roberttothsculptor.com/

Shipping & Handling
Up to $100 add $20 $101.-$150. add $23 $151.-$200. add $25 $201.-$250. add $28
$251.-$300. add $30 $301.-$350. add $33 $351.-$400. add $35 $401.-$450. add $38
DESCRIPTION Engraved name plate available QTY $ EACH $ TOTAL
$ $
Total
Shipping and Handling
North Carolina Residents Add Sales Tax
Total Enclosed

Please Print Shipping Address – Please print NAME as it appears on CREDIT CARD.

NAME__________________________________________PHONE_________________________

ADDRESS__________________________________Email________________________________

O  Business Address      O  Home Address

CITY_____________________________________ST_______ZIP______________
……………………………………………………………………………………………………………………
CREDIT CARD, Check one…………..|…………………Make checks payable to RT DESIGNS USA
VISA|___|….. MC|___|….. Exp. Date____________________________

CARD #_____________________________________________________| 3 Digit Code (Back of Card) _________

Signature__________________________________________________Date______________
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