Rainbow Gifts Mail Order Form

Rainbow Gifts

PO Box 158

Moline, IL. 61266

Phone (309) 764-0559

Fax (877) 606-4724

****** ORDERED BY *******                     ****** SHIP TO *******   (If different)

NAME:          ________________________       NAME:          ________________________

Street:        ________________________       Street:        ________________________

City:          ________________________       City:          ________________________

State/Province:________________________       State/Province:________________________

Zip/PostalCode:   _____________________       Zip/PostalCode:   _____________________

Email Address: ________________________       Email Address: ________________________

** Merchandise Order **

PRODUCT NUMBER  PRODUCT NAME         COLOR/SIZE/STYLE   HOW MANY?  PRICE    TOTAL FOR

                                                                            PRODUCT

______________  ___________________  _______________    _________  _______  _________

______________  ___________________  _______________    _________  _______  _________

______________  ___________________  _______________    _________  _______  _________

______________  ___________________  _______________    _________  _______  _________

______________  ___________________  _______________    _________  _______  _________

______________  ___________________  _______________    _________  _______  _________

      *** SHIPPING & HANDLING CHARGES ***                PRODUCT TOTAL:     _________

                                          SALES TAX(IL.) Residents Only 7%:________

Flat Rate $6.00 Shipping and Handling Charge (USPS Priority Only)

USPS Express/UPS and International Charges Additional

(Call for Shipping Charges)

                                              |---------> SHIPPING & HANDLING: _________

                                                            TOTAL:               _________

Credit Card Information

(Optional - complete only if paying by Credit Card)

Card Type: __________  Card Number: ______________  Card Expiry (eg. MM/YY):___________

Cardholder Name: ___________________   Card Holder Signature: __________________

Mail Order with Check/Money Order/Visa/Mastercard/Discover to:
Rainbow Gifts
PO Box 158
Moline, IL.
61266

Contact us on-line:
Rainbow Gifts is located at http://www.rainbowgifts.net on the web.
Find out How to Reach Us if you have suggestions or questions.

You can also fax your order:
Telephone
(309) 764-0559
Local Fax: (877) 606-4724