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Gemini Publishing Co. Secure Order Form
Warning: When entering data in this form please do not use the Enter key on your keyboard. Use your mouse & cursor to enter data.
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*
Enter Item# with Description, Price and Quantity
Item 1:*
Item 2:
Item 3:
Item 4:
Item 5:
Item 6:
Item 7:
Item 8:
Sub-Total:
Tax (TX 6.50%):
Shipping for U.S. Orders
Choose
Shipping for U.S. Orders
First Class or Media Mail Rate - 1 Item $4.00
First Class or Media Mail Rate - 2 Items $5.00
First Class or Media Mail Rate - 3 Items $6.00
First Class or Media Mail Rate - 4 Items $7.00
First Class or Media Mail Rate - 5 Items $8.00
First Class or Media Mail Rate - 6 Items $9.00
First Class or Media Mail Rate - 7 Items $10.00
First Class or Media Mail Rate - 8 Items $11.00
Shipping for Canadian Orders:
Choose
Shipping for Canadian Orders
First-Class Mail International - 1 Item $10.00
First-Class Mail International - 2 Items $13.00
First-Class Mail International - 3 Items $16.00
First-Class Mail International - 4 Items $19.00
First-Class Mail International - 5 Items $22.00
First-Class Mail International - 6 Items $25.00
First-Class Mail International - 7 Items $28.00
First-Class Mail International - 8 Items $31.00
Shipping for Foreign Orders:
Choose
Shipping for Foreign Orders
First-Class Mail International Shipping - 1 Item $12.00
First-Class Mail International Shipping - 2 Items $20.00
First-Class Mail International Shipping - 3 Items $28.00
First-Class Mail International Shipping - 4 Items $36.00
First-Class Mail International Shipping - 5 Items $44.00
First-Class Mail International Shipping - 6 Items $52.00
First-Class Mail International Shipping - 7 Items $60.00
First-Class Mail International Shipping - 8 Items $68.00
Grand Total:
*Quantity discounts will be deducted from your total when credit card is charged
Billing Information
First Name*
Middle Initial:
Last Name:*
Address Line 1:*
Where your statement is mailed
Address Line 2:
Apt. or Suite No.
City:*
State:
Choose a State
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Alaska
Arizona
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California
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Delaware
District of Columbia
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Maine
Maryland
Massachusetts
Michigan
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Country*
Zip Code/Postal Code:*
Phone:
Shipping Information
Same as billing info:*
Yes
No
First Name:*
Middle Initial:
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Country*
Zip Code/Postal Code:*
Payment Information
Payment Method:*
Credit Card
For Those of You Who Wish to Pay for Your Order Using PayPal Click Here                      Â
Card Number:*
No dashes or spaces please
3 or 4 digit Security Code*
Security Code on back of card
Expiration Month:*
Month
January
February
March
April
May
June
July
August
September
October
November
December
From your card
Expiration Year:*
Year
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
From your card
Card Brand:*
Choose a Card
American Express
Discover
Master Card
Visa
JCB
Diners Club
Comments:
Quantity discounts will be deducted from your total when credit card is charged.
Remaining Characters
1000 Character Limit
Gemini Publishing Co., PO Box 293535, Kerrville, TX 78029, 830-496-3337, Website: www.getgirls.com, email: getgirls@getgirls.com
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