DR. CHUDS MAIL ORDER
Print this form, fill it out and WRITE CLEARLY! - Include it with your order.
If you don't have a printer, hand write CLEARLY, all necessary info on a sheet of paper and include it with your order.

NAME: _________________________________________________________________________________

ADDRESS: ______________________________________________________________________________

CITY: ____________________________________________STATE: ________________________________

ZIP, POSTAL CODE: ____________________________COUNTRY_________________________________

E-MAIL ADDRESS: ________________________________________________________________________

MERCHANDISE
QTY OF: ____________Dr. Chuds Deathguard Flag Pin, ..........................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds Cross Pin, .............................................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds Got Blood Pin, .....................................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds X-Ward Logo Pin, ..............................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds Diagnosis For Death Pin, ..................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds Dr.Pumpkin Pin, ..................................................$1.00 each....= $___________
QTY OF: ____________Dr. Chuds Headnurse Pin, ...................................................$1.00 each....= $___________
QTY OF: _______Dr.Chud 2007 DRUM STICK,.........................................................$10.00 each...= $___________
QTY OF: _______SACRED TRASH CD,......................................................................$10.00 each...= $___________
QTY OF: _______SACRED TRASH CASSETTE,..........................................................$8.00 each..= $___________
QTY& SIZE OF: _________X_________2000 HALLOWEEN T-Shirt,...................$12.00 each..=.$___________
QTY& SIZE OF: _________X_________2002 HALLOWEEN T-Shirt, ..................$12.00 each..= $___________

SHIPPING AND HANDLING:
USA: (1-2 items) $4.00, (including buttons)
(If ordering more than 2 items, include $1.00 for each additional item ordered excluding buttons)
Canada: (1-2 items) $5.00, (If ordering more than 2 items, include $1.50 for each additional item ordered)
Mexico, Brazil & Argentina: (1-2 items) $8.00, (If ordering more than 2 items, include $1.00 for each additional item ordered)
Australia, New Zealand & Japan: (1-2 items) $13.00, (If ordering more than 2 items, include $2.00 for each additional item)
UK, Holland, Finland , Sweden, Germany, Austria, Luxembourg, Italy, Spain, Wales, Poland, France & Denmark:
(1-2 items) $11.00, (over 2 items, include $1.00 for ea. additional item)
If your Country is not listed here E-MAIL us at chudmerch@hotmail.com

TOTAL # OF ITEMS ........................_____________
TOTAL PRICE OF ITEMS........................................................... = $____________
TOTAL PRICE OF SHIPPING..................................................... = $____________
GRAND TOTAL ENCLOSED...................................................... = $____________

All orders must be in the form of International or U.S. Money Orders or
well conceled U.S. Cash or Cashiers Check..
NO PERSONAL CHECKS WILL BE ACCEPTED!
NO C.O.D'S, NO FORIEGN CHECKS!
Payment in full must accompany order.
Allow 3-6 weeks for delivery
SEND MONEY ORDER PAYABLE IN U.S. DOLLARS, MADE OUT TO CASH!
All checks NOT made out to "Cash" will be sent back.

Mail To:
DRCHUD
P.O. Box 16,
Lodi, New Jersey
07644
U.S.A.