DOWN ISLAND INC. Order Form
111 South Front Street * Wilmington, NC 28401
910 -762-2112

Please fill in and print the form below then fax it to us at 910-762-0270
(All information is confidential and will never be sold or shared to any 3rd party.
It will be associated only to your account.)

First Name: Last Name:

Billing Address:
Address 1: City: State:
Zip or Postal Code: Country: Daytime Phone:

Shipping address if different from above:
Address 2: City: State:
Zip or Postal Code: Country: Daytime Phone:

ITEMS :
Qty: Item #: Item Name: Price:
Qty: Item #: Item Name: Price:
Qty: Item #: Item Name: Price
Qty: Item #: Item Name: Price:
Qty: Item #: Item Name: Price:
Qty: Item #: Item Name: Price
Qty: Item #: Item Name: Price :
Shipping and Handling Charges:
Up to $20.00 $7.95 $75.01 - $85.00 $13.95
$20.01 - $30.00 $8.95 $85.01 - $100.00 $15.95
$30.01 - $45.00 $10.95 $100.01 - $200.00 $18.95
$45.01 - $60.00 $10.95 Over $200.00 18%
$60.01 - $75.00 $12.95 Certain oversized,
heavy or odd shape items
Customer will be called if extra handling charges apply

Subtotal:
7% NC Sales Tax:
Shipping & Handling:
Total Due:

910 -762-2112