LEIS OF HAWAII

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?

- - - - - - - - - - - - - - Type Of Leis - - - - - - - - - - - - - - - Lei Description - - - - - - - - - - - - - - - - - - Total

9 Packs Green	9 Packs Purple	9 Packs White	9 Packs Imsw	8 Packs Jury Red

*PACKING*

INCLUDED

PACKING/HANDLING/AGRICULTURE USDA STAMP

BOX CHARGE: MAINLAND - NEIGHBOR ISLAND - INTERNATIONAL

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

*SHIPPING*

INCLUDED

Federal Express: Priority Overnight Service:

Or

Federal Express: Priority Overnight With Saturday Service:

*FEDERAL EXPRESS*

INFORMATION

• West Coast: Priority Overnight next business day to most of the West Coast which includes:

Arizona, California, Colorado, Idaho, Nevada, Oregon, Utah and Washington.

No Delivery: On SUNDAY & MONDAY - Except VIA  Airlines at an additional cost.

• East Coast: Priority Overnight second business day to all of the East Coast:

No Delivery On SUNDAY, MONDAY & TUESDAY - Except VIA Airlines at an additional cost.

(Some rural areas do not qualify for this overnight service. We will check the zip code for you. Orders that qualify for overnight delivery can be shipped Monday through Friday.)

FOR SECURITY REASON AND TO DOUBLE PROTECT YOUR CREDIT CARD INFORMATION

WE ASK IF YOU WOULD EMAIL SEPARATED (3) INFORMATION BELOW

1. Credit Card Number, 2. Name On Card, 3. Email Address

To: - leisofhawaii@msn.com

Payment: Visa or Master Card accepted through LEIS OF HAWAII

Credit Cards Type: Choose One Visa MasterCard American Express Discover

1. 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

2. 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 - 3. 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.

E-mail:

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