Roberts Eyewear
Safetyglasses.com

5480 San Juan Ave
Citrus Heights, CA 95610
Tel: 916-967-1980
Fax: 916-966-1223
Email: RobertsEyeWear@gmail.com

Purchase Order No: __________________
Date:__________________


Billing Information

Name

Street

City                  
                                                                State                    Zip          

Phone

E-Mail

Shipping same as Billing _______ Please Check


Shipping Information

Company Name

Attn:

Street

City                                  
                                                               State                 Zip               

Phone

E-Mail

 

QTY. ITEM NO. NAME OF ITEM ITEM PRICE TOTAL
              |  
              |  
              |  
              |  
              |  
              |  
              |  
              |  
              |  
              |  

SHIPPING CHARGE

   Flat Rate Domestic

$7.95

    1-2 Business Days up to 1lb.

$40.00

    3-4 Business Days up to 1lb.

$20.00

    Canada up to 1lb.

$25.00

    International up to 1lb.

$60.00

TOTAL: $__________

TAX 8.00% CA RESIDENTS ONLY
TAX AMOUNT: $ __________

GROUND SHIPPING: $ __________

EXPRESS SHIPPING:$__________

 TOTAL ENCLOSED: $ __________

 
 
METHOD OF PAYMENT:   
 Money Order   
 *Personal Check

* (5 days hold on personal checks) Payable to: Roberts Eyewear

Charge to:   
 Visa   
 MasterCard   
 American Express   
 Discover

 

Card #                                                                               Exp. Date        /       

 

Security Code                    Cardholder's Name                                                                       

 

By signing below, I certify that I have read and understand the policy.

 

X ________________________________________

Orders will not be accepted without signature

Thank you for your order!


Visit  safetyglasses.com  for Guarantee & Return Policy