To Place an Order, Please Fill Out and Print The Following Form.

Return along with your check or money order to:

D.S.A. Enterprises
P.O. Box 268
Jennerstown, PA 15547

International shipments have proven to be rather costly, however we wish to offer our products world wide and most items can be delivered Internationally. We will contact you if International delivery is not possible. Prices do not include shipping or duty. Please allow 3 to 6 weeks for US delivery. All others, please allow additional time.

Please read our Ordering Information if you have any questions. By placing your order, you agree to the terms of our RETURN POLICY.

D.S.A Enterprises Order Form

Quantity	Product #	Product Name ( If applicable, include personalization/color/print format/etc.)	Unit Price	Total Price
Quantity a	Product # a	Product Name a	Unit Price a	Total Price a
Quantity b	Product # b	Product Name b	Unit Price b	Total Price b
Quantity c	Product # c	Product Name c	Unit Price c	Total Price c
Quantity d	Product # d	Product Name d	Unit Price d	Total Price d
Quantity e	Product # e	Product Name e	Unit Price e	Total Price e
Quantity f	Product # f	Product Name f	Unit Price f	Total Price f
Quantity g	Product # g	Product Name g	Unit Price g	Total Price g
Quantity h	Product # h	Product Name h	Unit Price h	Total Price h
Quantity i	Product # i	Product Name i	Unit Price i	Total Price i
Quantity j	Product # j	Product Name j	Unit Price j	Total Price j
			Sub Total
			Shipping (See chart below)
			Sub Total
			PA Sales Tax
			Grand Total

We require a $7.00 minimum shipping and handling charge.
PA residents add 6% sales tax to your order.

Order Price	Please Add Shipping To Your Total
Up to $100	$7.00
$100.01 - $150	$9.00
$150.01 - $200	$12.00
$200.01 - $250	$15.00
$250.01 - $300	$17.00
$300.01 - $350	$20.00
$350.01 - $400	$22.00
Over $400	$25.00

Customer Information

Day Phone:

Evening Phone:

E-Mail Address:

Customer Address:

Name on the Bill:

City:

State/Province:

Zip/Postal Code:

Country:

THANK YOU FOR YOUR BUSINESS!

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D.S.A. Enterprises Office Use Only:

___Money Order ___Check (Check No._____) Date Recieved____________