Company Ship To:

c/o Name:

Address:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

Contact Name:

How did you hear of our company?

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BOX CHARGE: MAINLAND - NEIGHBOR ISLAND - INTERNATIONAL

Qty () - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $

PACKING/HANDLING/AGRICULTURE USDA STAMP ($5.95 PER BOX)

Important notice - Placing last minute orders to be shipped the same day is subject to a surcharge fee of $15.00 Airbill.

SAME DAY SERVICE ORDER ($15.00)

Important notice - Federal Express Charges $12.50 more per box for Saturday Delivery. You may wish to receive your shipment on Friday for that weekend. Shipping to any State east of the Colorado Mountains is two days delivery from Hawaii.

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- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -HI Tax 4.5%   $

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Payment: Visa or Master Card accepted through LEIS OF HAWAII

Credit Cards Type: Choose One Visa MasterCard

Card No:

This Credit Card Will Not Be Valid Unless You Submit Your

Last 3 Digit Numbers Located On The Back Of Your Credit Card:

#

Exp. Date: 00/00

Name Of Person As It Appears On The Card:

Credit Card Billing Address:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

When complete, click "submit" to email Leis Of Hawaii. If you wish to have a hard copy of your order, please print "Form Confirmation" page after submitting. Please allow processing time. You will be contacted by your email below once your Credit Card has been approved, which will confirm your order. You will be contacted by your email if there is any problem with your order.

AVS (Address Verification Service

When complete, click "submit" to email Leis Of Hawaii. If you wish to have a hard copy of your order, please print "Form Confirmation" page after submitting. Please allow processing time. You will be contacted by your email below once your Credit Card has been approved, which will confirm your order. You will be contacted by your email if there is any problem with your order.

E-mail:

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