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Order Form

sales@shrimatis.com
2011 University Avenue
Berkeley, CA 94704 USA

Tel: (510) 548-6220
Fax: (510) 548-1838
Store Hrs: Mon to Sat 10 to 6pm / Closed Sunday
Ship to Business address [    ] Residence [    ]

Name:_______________________________________________
Ship to:__________________________________________________

____________________________________________________

Date:____/____/________

Phone Residence:_(____)_____-_________

Phone Work:_(____)_____-________

Charge to Amex, Discover, M/C or Visa:  Card #: ______________________________________________ Exp.Date____/____

 Issuing Bank: ____________________________________   Customer email: _________________________________________

If paying by an enclosed check, amount of check: US$_____.___      Credit card billing address if different from shipping address above:

________________________ ____________________ ____________________________ ________________________________

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California residents please add 8.75% Sales Tax

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Shipping and handling by UPS / USPS 1st Class Mail  (Commercial $5.50) (Residential $6.00)  in continental USA / USPS Media Mail Shipping $3.99 / Overseas Shipping from $6.00 Onwards

$

TOTAL

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