Please print this form and use it for your "Mail Order" from Great Scott!

Name : ______________________________ Day & Eve. Phone: ______________/______________

Street : ______________________________ Email : __________________________

City : ________________________________ State: ________ Zip:_______________

If you'd like your book(s) autographed by Blackie to someone special, please indicate below.

Item #

Title

Quantity

Price Each

Total

      $ $
      $ $
      $ $
      $ $

Alternate choice (if one of the above is not available)

        $ $
        $ $
        $ $
Send your gift to a friend:
Name:
Merchandise Total........................ $
Shipping & Handling................... $
Address: Subtotal......................................... $
City: Sales Tax 7.0% (Ga. only)......... $
State: Zip: Total Amount Enclosed................. $

Autographing:
 
 
 
 


Shipping & Handling Charges

Payment Method

UPS Ground
1st Item........................$5.00
Each Additional Item....$1.00
Payment Method: Personal Check _____ Money Order _____
UPS 2nd Day Air
1st Item........................$15.00
Each Additional Item....$3.00

Office Use Only:

 Date: ________________________
 Auth ticket #: _________________
 Invoice #: ____________________
 Ref: _________________________
 Date: ________________________

Make Checks or Money Orders Payable to:
Blackie Scott
1498 Brianwood Road
Decatur, GA 30033

Call: 1 404.636.5695

Visit us at: http://www.blackiescott.com

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