Stephenson County Historical Society: Order Form

Name: ________________________________________________________________ Day Phone:

Address: ______________________________________________________________ Evening Phone:

City, State, Zip Code: ____________________________________________________

E-Mail Address:

If your merchandise total is (not including tax):	Shipping & handling charges are:
$0.50 to $20.00	$7.00
$21.00 to $40.00	$10.00
$41.00 to $65.00	$12.00
$65.00 to $85.00	$14.00
Over $85.00	Please call (815.232.8495)

Total Merchandise

Sales Tax – Add 8% (.08) ________

Shipping Charge (see table at left)

$_____________

Total Enclosed

Make Check Payable to: SCHS