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Qty

Catalogue

Number

Color

Size

Item Description

Unit Price

Total Price

Name:         

Merchandise

Total

Street:           

City:              

State:           

Zip:              

Surface Shipping & Handling (add charge from chart below)  
Shipping        

Address if    

different        

from above.

Order total

This is an original order.

This is an additional or changed order.

E-mail address:   Payment Method (please select)

Check

Money Order

Credit payment through PayPal.com

You will get a response from

Maridana within 48 hours. 

Thank you for your order!

Total Order Amount

Regular S&H

(Surface)

Total Order Amount

Regular S&H

(Surface)

Up to $5.00

$3.99

$65.01 to $75.00

$10.00

$5.01 to $15.00

$4.99

$75.01 to $100.00

$11.99

$15.01 to $25.00

$6.99

$100.01 to $150.00

$12.99

$25.01 to $35.00

$7.99

$150.01 to $200.00

$13.99

$35.01 to $45.00

$8.99

$300.01 to $500.00

$15.99

$45.01 to $65.00

$9.99

Over $500.00

$16.99

Thank you for your order.

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