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Printable Order Form


Printable form for mail, FAX, or phone.
Pomegranate Communications, Inc.
19018 NE Portal Way, Portland, OR 97230
800.227.1428       FAX 503.328.9330

Billing Information Shipping Address (if different)
Name
____________________________________
Name
_____________________________________
Address
____________________________________
Address
_____________________________________
City                       State             Zip
____________________________________
City                       State             Zip
_____________________________________
Phone
____________________________________
Phone
_____________________________________
Email
____________________________________
Email
_____________________________________
 Description  Item Number  Qty  Unit Price  Total
         
         
         
         
         
   Total:  
 Shipping:  
 8% tax in CA:  
 Grand Total:  
Shipping Charges for Ground/Surface Transportation    Please call us for air shipping rates (USA only).
Order Total   To USA   Order Total   To Canada   Order Total   International*  
up to $9.99   add $2.95   up to $14.99   add $4.80   up to $20.99   add $15.00
$10.00-$14.99   add $3.95   $15-34.99   add $14.40   $21-35.99   add $20.00
$15.00-$19.99   add $4.95   $35-64.99   add $20.99   $36-50.99   add $25.00
$20.00-$34.99   add $6.95   $65-99.99   add $25.99   $51-64.99   add $30.00
$35.00-$49.99   add $8.95   $100-149.99   add $31.99   $65-74.99   add $45.00
$50.00-$64.99   add $10.95   $150-199.99   add $36.99   Over $75 Contact Us
For Pricing
$65.00-$74.99   add $12.95   $200 and over   Free!      
$75 and up   Free!                
                   

* International shipping available to major countries including: the UK, Europe, New Zealand, Australia, Asia. International rates are subject to price adjustment; if necessary we will contact you.

Method of Payment       ___ Check or money order     ___ American Express VISA Mastercard Discover

Card # _____________________________

Expiration (MM/YY) __________

Signature ___________________________

Card Verification Number __________
(The last 3 digits on the signature panel on the back of the card. Not required for American Express.)

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