Fax or Mail Order Form

The House of Rice Store

3221 N. Hayden Road

Scottsdale, AZ. 85251

United States toll free (877)469-1718

Local or International (480)947-6698

Fax (480) 947-0889



PHONE / FAX / MAIL ORDER FORM

Name_________________________________________________

SHIPPING ADDRESS_____________________________________

Suite or Apt. number_________________

CITY_________________________STATE______ZIP__________

Phone # (________)__________________________

If you are paying by Credit Card, we will need the address where the credit card bill is mailed to. If it is the same as above, write "Same". Skip the following information if paying by money order or check.

BILLING ADDRESS__________________________________________________________

Visa, MasterCard, American Express and Discover.

CARD #_______-_______-________-_________EXP___/___

CVV#________(on Visa, MasterCard, Discover the 3 digits are located on the very right hand side of signature box. On AMEX, the 4 digits are printed on the front right of card)Skip if paying by Money order or check.

Quantity/Item #/ Description / color,size / price/ total

_____/_________/______________/_______/_________/________

_____/_________/______________/_______/_________/________

_____/_________/______________/_______/_________/________

_____/_________/______________/_______/_________/________

_____/_________/______________/_______/_________/________

_____/_________/______________/_______/_________/________

sub-total__________ shipping __________ total ____________

Shipping/handling rate chart: Up to $10.99 $5.95, $11.00 to $19.99 $6.95, $20.00 to $29.99 $7.95, $30.00 to $39.99 $8.95, $40.00 to $49.99 $9.95, $50.00 to $59.99 $10.95, $60.00 to $69.99 $11.95, $70.00 to $79.99 $12.95, $80.00 to $99.99 $13.95, 100.00 to 109.99 $14.95, 110.00 to 139.99 $15.95, $140.00 and up $16.95

(Standard shipping for shipping addresses within the 48 contiguous USA is free for purchases over $100.00!)

*If you pay with a personal check, orders will be held 2 weeks for the check to clear. If you pay with a money order, your order will be processed right away and shipped via US Mail or ground UPS depending on the weight.

For other UPS services or FOR SHIPMENTS OUT OF THE UNITED STATES, please call or write for rates.

Thank you for your order! *Orders are normally sent out within 48 business hours of receipt unless paid for with a personal check.