Colorado Backporch Order Form
Mail Order Form - Please Print this Form, fill it out, and send via regular mail to:

Colorado Backporch
17030 E. Wiley PL
Parker, CO 80134

Name: Date:

Shipping Address:
Phone #:
Email :

City, State:

Billing address if different:

Zip
Zip:

	Qty	Description	Price Each	Line Total
1
2
3
4
5
6
7

Shipping Charges
Patterns and/or Fabric
$0 - $35.00	$5.60
$35.01 - $55.00	$7.05
$55.01 - $80.00	$9.05
Over $80	12%

Sub Total
Tax (CO)
Shipping
Total

	VISA	Master Card
Card Number
Ex Date
CVC number-found back of card in signature box
Name On Card
Signature

For residents of Colorado, add tax of 8.010%.

Credit card orders are shipped within 48 hours. Payment by check will require 5 to 7 additional business days prior to shipment of your order.

Foreign orders must be Credit Card only, and must include your email address. When shipping charges are figured, we will email you the final shipping charges for you to approve prior to charging your credit card.

Name:	Date:
Shipping Address:	Phone #: Email :
City, State:	Billing address if different:
Zip	Zip: