HERRSCHNERS ® ORDER FORM 2800 Hoover Road, Stevens Point, Wisconsin 54492 Check appropriate box Address for this shipment only. and fill in below. Permanent Change of Address. Please Print. Name: _____________________________________________________________________________ Address: ____________________________________________________________________________ City: ________________________State/Province: ___________ ZIP/POSTAL CODE: ____________ Daytime Phone: Area Code ( ) Number: ____________________________________________ CUSTOMER SERVICE 1-800-713-1239 MONDAY-FRIDAY, 7:30 AM TO 5 PM CT or Email us: [email protected] ORDER TOLL-FREE 1-800-441-0838 7:30 AM TO 11:00 PM CT, 7 DAYS A WEEK FAX ORDERS • 1-715-341-2250 ORDERED BY: If address is new or incorrect, please make corrections. If you need more space, please attach a sheet of paper. ORDER ONLINE: Herrschners.com SPECIAL NOTE: To receive special notifications via email, please provide your email address. We never share your email address. Email address: PAY ONLINE WITH INTERNET ORDERS ONLY PLEASE COMPLETE A SEPARATE ORDER FORM FOR EACH SEPARATE SHIP TO ADDRESS. PAGE NO. ITEM DESCRIPTION ITEM NUMBER SIZE OR COLOR NUMBER QUANTITY PRICE EACH EXTENDED AMOUNT DOLLARS CENTS MERCHANDISE TOTAL ADD SHIPPING & PROCESSING CHARGES FROM TABLE AT LEFT SMARTSAVINGS CLUB MEMBERS TAKE 10% OFF MERCHANDISE TOTAL SUBTOTAL TOTAL AMOUNT OF ORDER SHIPPING & PROCESSING RATES (Contiguous United States Only) Insured Delivery is Guaranteed Add $2.95 to ship to Canada. Add $4.95 to ship to Alaska, Hawaii, & Puerto Rico. Rush delivery not available in these areas. Signature _____________________________________________________________ $0.00 to $10.00.............................. $4.99 $10.01 to $20.00............................ $7.99 $20.01 to $40.00.......................... $10.99 $40.01 to $60.00.......................... $12.99 $60.01 to $80.00.......................... $13.99 $80.01 to $150.00........................ $14.99 $150.01 & Over ................... 10% of Order PAYMENT METHOD *If you are unsure of your state, province or local tax rates, visit Herrschners.com/Taxes or call 1-800-441-0838. | | | | | | | | | | | | | | | | | Exp | | | | | ADD STATE AND LOCAL TAX TO SUBTOTAL* Check Money Order VISA MasterCard Discover American Express

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HERRSCHNERS® ORDER FORM2800 Hoover Road, Stevens Point, Wisconsin 54492

Check appropriate box Address for this shipment only.and fill in below. Permanent Change of Address.Please Print.Name: _____________________________________________________________________________

Address: ____________________________________________________________________________

City: ________________________State/Province: ___________ ZIP/POSTAL CODE: ____________

Daytime Phone: Area Code ( ) Number: ____________________________________________

CUSTOMER SERVICE

1-800-713-1239MONDAY-FRIDAY, 7:30 AM TO 5 PM CT

or Email us: [email protected]

ORDER TOLL-FREE1-800-441-0838

7:30 AM TO 11:00 PM CT, 7 DAYS A WEEK

FAX ORDERS • 1-715-341-2250ORDERED BY: If address is new or incorrect, please make corrections.

If you need more space, please attach a sheet of paper.

ORDER ONLINE: Herrschners.com

SPECIAL NOTE: To receive special notifications via email, please provide your email address. We never share your email address.Email address:

PAY ONLINE WITH

INTERNET ORDERS ONLY

PLEASE COMPLETE A SEPARATE ORDER FORM FOR EACH SEPARATE SHIP TO ADDRESS.

PAGENO. ITEM DESCRIPTION ITEM NUMBER

SIZE OR COLORNUMBER QUANTITY PRICE EACH

EXTENDED AMOUNT

DOLLARS CENTS

MERCHANDISE TOTAL

ADD SHIPPING & PROCESSING CHARGES FROM TABLE AT LEFT

SMARTSAVINGS CLUB MEMBERSTAKE 10% OFF MERCHANDISE TOTAL

SUBTOTAL

TOTAL AMOUNT OF ORDER

SHIPPING & PROCESSING RATES(Contiguous United States Only)

Insured Delivery is Guaranteed

Add $2.95 to ship to Canada. Add $4.95 to ship to Alaska, Hawaii, & Puerto Rico. Rush delivery not available in these areas.

Signature _____________________________________________________________

$0.00 to $10.00 .............................. $4.99$10.01 to $20.00 ............................ $7.99$20.01 to $40.00 .......................... $10.99$40.01 to $60.00 .......................... $12.99$60.01 to $80.00 .......................... $13.99$80.01 to $150.00 ........................ $14.99$150.01 & Over ................... 10% of Order

PAYMENT METHOD

*If you are unsure of your state, province or local tax rates, visit Herrschners.com/Taxes or call 1-800-441-0838.

| | | | | | | | | | | | | | | | |

Exp | | | | |

ADD STATE AND LOCAL TAX TO SUBTOTAL*

Check Money Order

VISA MasterCard Discover American Express

20401_HER

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