This form is intended for stocked items (supplies and RPE# panels) available for 7-10 day ship date.
Please note ... all made-to-order panels, please contact us for lead time. Fill out this form, and mail with payment to: Country Accents ®, 1723 Scaife Road, Williamsport, PA 17701

Phone: (570) 478-4127 (M-F
9-5 ET) Fax: (570) 478-2007 website: www.piercedtin.com

PLEASE PRINT CAREFULLY

Name ________________________________________________________________________________________

Phone (___________) ___________ - ____________________ Date of Order ___________________________

Street Address ________________________________________________________________________________
                          Please use a street address for shipping. UPS will not deliver to a Post
Office Box.

City _______________________________________ State ______________________ Zip ___________________

MINIMUM ORDER $15.00 (not including shipping charges). Blank tin has separate $15.00 order minimum.
MINIMUM SHIPPING FEE is $9.00. If your order exceeds $60.00, please add a flat rate of 15% for shipping and handling. Ship date for supplies: approx. 7-10 working days. Prices subject to change without notice.

Quantity Product # / Description Size (if applicable) Price
       
       
       
       
       
       
       
       
       
Indicate Payment Method:
 Personal CheckMoney Order VISA MasterCard Discovery
Acct No (all digits)
                               

exp date ______/______
Signature (required if using credit card): _______________________________

  • For deliveries in PA please add appropriate sales tax figure after shipping charges are computed.
  • For shipping to Canada or Abroad, please call us. Phone 570-478-4127, M-F 9-5 ET.
Subtotal  
Shipping (see above)  
6% tax (PA only)  
TOTAL ENCLOSED  
 

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