Rosalyn Smith Designs, Inc.
673 Poindexter Road - Brighton, TN  38011
Phone: 901-476-3584
Fax:901-475-4499

Ordered by: 

Name

Address                                                                                  Apt #

City                                          State                                      Zip

Phone:   Day                                        Night              

Email

Ship to: Orders ship UPS or Post Office. Please provide both physical address and mailing address.
Shipping charges are listed on the Contact Us page of the website.

If total order is for 1 or 2 license plates only, shipping is $6.95 and will be sent post office and requires a mailing address.

Name

Address                                                                                  Apt #

City                                          State                                      Zip

Phone:   Day                                                  

Item No.

Item Description

Color

Size

Qty

Price

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If more space is needed, please print an additional copy.

Merchandise    SUBTOTAL                

 

S & H    (see shipping chart)

 

Add  .0925 % TN sales tax only if delivered inside Tennessee

 

                           TOTAL

 

Method of Payment:
 MasterCard      Visa      American  Express     Check    Money Order

Credit Card No.______________________________________   Exp: __________  Security Code: ______

Name as it appears on credit card:____________________________________________________

Billing address for credit card
(Only if different from "ordered by")

__________________________________________________________________________________________________
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