WAIPUILANI
ORDER FORM
Name:______________________________________________
Address:____________________________________________
City:___________________ State:_______ Zip code_____-____
Phone Number:_______________________________________
Mailing Address:______________________________________
City:______________ State:____ Zip Code______-____
PRODUCTS:
Item:___________________________________________________________________________________________
Quantity:________ Unit Price: $_______________ Total Cost $:__________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Item:___________________________________________________________________________________________
Quantity:________ Unit Price $________________ Total Cost: $_________
Sub-Total Cost of Order: $___________________________
Taxes: (@ 4.12%) : $_______________________________
Shipping & Handling: $_______________________________
Grand Total: $______________________________________
If you are a Retail Business you will need to give us your Business Licenses Number before ordering from this website.
Name of Business:__________________________________________________________________________________
Address of Business:________________________________________________________________________________
City:_______________________________ State:__________ Zip code:______________________
Business License Number:__________________________________________________________
State of Issuance:____________ Expiration Date:________________________________________
Date License Issued:_______________________________________________________________
Type of Business:_________________________________________________________________
Owner of Business:________________________________________________________________
PAYMENT METHODS:
You may pay by Cashier Check or Money Order, make sure when you do make out a cashier check or money order that you make it out to the company WAIPUILANI, Also allow 2 to 6 weeks for delivery of your order. We ship all orders by United States Post Office, unless other wise specified. If you have any problems contact us at kawikaj@yahoo.com
