ORDER FORM
(print and mail this form with your order)

Small 6" x 12" $63.00
Medium 6" x 18" $83.00
Large 6" x 24" $99.00

Shipping and handling is $12.00 per Capsule ordered.

I would like ____    Small, at $63.00 Each for a total of $__________
I would like______ Medium, at $83.00 Each for a total of $__________
I would like ____ Large, at $99.00 Each for a total of $__________
 I live in California and my 8.25% sales tax is $__________
If you don't live in California leave this line blank                                  
Shipping and handling $__________
TOTAL:$__________

Make Checks Payable To : AffordableTimeCapsule.com
P.O. Box 851 Concord, California 94522
 Please allow 4 - 6 weeks for delivery
SHIP TO:
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Please attach any PURCHASE ORDERS to this form.
Thank you for your order!