Fax/Mail Order Form
Please print then fax or mail:
Phone: 800.EYES.4U2
Fax: 707.829.2122

Allyn Scura Eyewear
708 Gravenstein Hwy. North #99
 Sebastopol CA 95472

 First Name:  Last Name:
 Street:  Unit#:
 City:  State:  Zip:  Country:
 Phone:(      )  Fax:(      )
 Email:
 
Allyn Scura - Vintage & Antique Frames
While shopping at the Vintage/Antique sections of our site, please make a note of the: Style# and Price.
Style#

Quantity

Price

 Extended Price
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Allyn Scura - Original Designs 
Available with clear 'Demo' lenses or with a choice of sunglass lenses. While shopping this section, please make a note of the: Style#, Frame Color Code#, Sunglass Lens Color (if applicable) and Price.
Style# Frame Color# Sunglass Color

Quantity

Price

Extended Price
1) __________ __________ ______________ ______ __________                          
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Domestic Shipping & Handling Rates:


Sub Total                         

UPS Ground- 1 item: $7.95; 2-10 items add $1.00 per item.
UPS 3-Day Air- 1 item: $16.95; 2-10 items add $1.00 per item.
UPS 2-Day Air- 1 item: $19.95; 2-10 items add $1.00 per item.
UPS Next Day- 1 item: $39.95; 2-10 items add $1.00 per item.

Please specify under the 'Comments' section if you would like US Postal Priority service (2-3 days) for $6.95 or Express Mail (1-2 days) for $16.95 (up to 8 oz.) for your domestic shipment. For international shipments, USPS Global Priority (4-6 days;uninsured) is $9.95 to Canada & Mexico, $11.95 to most other countries; USPS Global Express (2-3 days; insured to $100) is $22.95 to Canada & Mexico, $25.95 to most other countries.

*All domestic shipments insured at purchase price. Please call for specific rates on larger quantities and international shipments. Rates and service providers subject to change. Their may be additional expenses for "remote" shipping addresses as charged by our carrier.

 

Shipping                         
 
   
CA Residents may need to add 8.25% Sales Tax for non-RX merchandise:

Sales Tax                         

PAYMENT TERMS: Cashier's Check, Money Order, Credit Card or Personal Check (product ships after payment is cleared). We accept MC, Visa, American Express & Discover.


TOTAL                         

Type of Credit Card: __________________________
Credit Card#: _________________________________ Expiration Date:__________
 
Signature: _________________________________