ILMI JOHANNA
180 Rockland Road (Route 17)
Washington, ME 04574
http://www.ilmi-johanna.com
Email: sales@ilmi-johanna.com
Orders Only: (800) 974-9790
Info: (207) 845-2253 . . . . . . . . . . Fax: (207) 845-2128
Name
Address Apt.#
City State Zip
Telephone # EMail
Catalog #
Qty
Item Description
Price Each
Total
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Shipping & Handling Charges
 Total for Merchandise .
At Least
Up To
Add
 Shipping & Handling (see chart at left) .
$0.00
$15.00
$5.95
 Subtotal .
$15.01
$20.00
$6.95
 Maine Residents Only Add 5.0% Sales Tax .
$20.01
$32.00
$7.95
 Total Amount Enclosed .
$32.01
$50.00
$9.95
Method of Payment
$50.01
$75.00
$11.95
 ¨Check/Money_Order ¨Mastercard ¨Visa
$75.01
$100.00
$13.95
 ¨American_Express ¨Discover  
$100.01
$170.00
$16.95
 Acct.#: 
$170.01
And Up
10% of Total
 Expiration Date: ___/___
Each package sent to a separate address requires separate postage.  Dinnerware, which is extra heavy, will be charged at the UPS rate.  Non-United States addresses will be charged actual shipping costs +3% of the Total.
 Signature: