Order Form | Girl Scouts of the Western Reserve

Order Form
Reference your Girl Scout catalog while using this form. Payment Options: You may email your order and call us during business hours with your credit card # at 330-864-9933 or 800-852-4474. You may choose to include your card number on this form but this is not a secure site at this time. Emails of this form are delivered directly to the shop staff. Tax: Please add 6.25% sales tax to all items *except* official insignia. *Required

Name*
Troop/Group#*
I am a:*	Leader or Assistant Leader Girl Scout Parent or Guardian Girl Scout Other Customer
Email Address*
Address*
City*
State*
Zip*
Daytime Phone
Item #1	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #2	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #3	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #4	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #5	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #6	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #7	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #8	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #9	Item/Catalog # \| Description \| Size \| Price \| Tax
Item #10	Item/Catalog # \| Description \| Size \| Price \| Tax
Regular Shipping and Handling Charges	under $19.00 -$4.75 $19.00-$29.99 - $5.95 $30.00-$44.99 - $7.50 $45.00-$59.99 - $8.65 $60.00-$74.99 - $9.15 $75.00-$99.99 - $11.05 $100.00-$149.99 - $12.15 $150.00 or more - $13.20
Total Payment Due $*
I will call the shop with my Credit Card Number	The number is 330-864-9933 or 800-852-4474
I will fax the shop staff my credit card number	The fax number is 330-864-5720



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