Online Printable Order Form

Directions:
You may fill out the fields below and then print the form. You may also choose to print a blank form and hand write your information in.
Fax/Mail Order Form - PRINT THIS PAGE - Minimum Order $15.00
FAX: 920-227-4147 or Mail To: R&R Homestead, 2399 Loxley Ct., Suamico WI 54173
Ordered By
Name:
Address:
City:
State:
Zip Code:
Phone:
Email:
Shipping Address(if different than Ordered By)
Name:
Address:
City:
State:
Zip Code:
Payment Method(Select One)
CC Number:
     Expiration Date
Address:
Signature:
 
(Signature required only for credit card orders)
Qty.
Product Description(max 80 characters)
Price Each
Total
 
Merchandise Total:
Wisc. Add 5.5% Sales Tax:
Shipping Charge (use chart add $7.00 for shipments to Hawaii or Alaska:
Total:
Each Order Totaling
Up to $20.00
$20.01 to $35.00
$35.01 to $50.00
$50.01 to $65.00
$65.01 to $80.00
$80.01 to $100.00
$100.01 to $125.00
$125.01 to $150.00
Over $150.00
Please Add
$9.00
$10.00
$11.00
$12.00
$13.00
$15.00
$17.00
$18.00
20% of Total
The Small Print: Minimum Order is $20.00. Case Prices - Hawaii and Alaska add $7.00. All other items use SHIPPING CHART. Each mailing address is a UPS charge.
Print Order