Island Treasures -Original Gifts from Paradise   P.O.Box 700252  San Jose, California 95170   (408) 255-6579

Ordered By:

Name: ___________________________________________

Address:__________________________________________

City-State-Zip:_____________________________________

Phone: (____)__________________Country:_____________

Ship To:

Name: __________________________________________

Address:________________________________________

City-State-Zip:_____________________________________

Phone: (____)___________________Country:___________

Enclose payment (U.S. check or Money Order). Add appropriate Sates Tax to sub-total.  Allow 2-3 weeks for delivery whenever possible. Orders sent U.S. Postal Service or UPS Ground based on weight.

If Mastercard or Visa charge, please provide ALL INFORMATION NOTED BELOW.

Product Name                                                          |   Item Number (Letters and Numbers)         |     Quantity     |  Unit Cost        |   Total Cost

________________________________________|__________________________________|___________ |____________|_________

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________________________________________|__________________________________|___________ |____________|_________

________________________________________|__________________________________|___________ |____________|_________

________________________________________|__________________________________|___________ |____________|_________

________________________________________|__________________________________|___________ |____________|_________

Shipping/Handling Fee Chart

(based on sub-total amount)

Sub-Total Amount: $__________._____

California residents, add appropriate California Sales Tax: $__________._____

Shipping and Handling Fee from chart on left: $__________._____

For shipment to Canada add additional $14.95 per address, for shipment to other countries add $30.95 per address: $__________._____

For our Island Gift Bag Packaging Service, add $8.00 per mailing address: $__________._____

TOTAL AMOUNT DUE: $__________._____

Charge to my Mastercard or Visa Account.   Accurate information noted below:

Card Number: ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___

Valid From: ___ ___ - ___ ___            Expiration Date: ___ ___ - ___ ___ - ___ ___

Name as appears on card: _________________________________________________

Signature: ______________________________________________________________

ORDER FORM                                                                Order Date: _____________________________          

Refunds/Exchanges/Credits:

Send returns or exchanges via U.S. Postal Service. Return postage is non-refundable. Original method of payment will be credited, including initial shipping and handling fee.