Mr. Mailbox Order Form

Ship to/install address:

Name: Address1: Address2: City: State:Zip: Phone, Day: Evening:FAX: E-Mail:

Order information:

Mailbox (select one):

Keystone Select Mailbox Color Black White Green Mr. Mailbox Special Select Mailbox Color Black White Green Red Burgundy Taupe Blue Ivory Gray Vandal Resistant Select Mailbox Color Black White Green Burgundy Almond Select Size Small Medium Large Veeders Stainless Steel Select Size Medium Large

Personalization of Mailbox:

Custom Lettering: Select Layout Layout #1 Layout #2 Layout #3 Select Type Style Baskerville Clarendon Helvetica Select Color White Black Gray Green Beige Metallic Gold Red Dark Brown

Post (select one):

Aluminum Post Select Post Color Black White Green     Keystone Deluxe Post Select Post Color Black White Green   Cedar Post Select Post Style Description Chamfer Top Chamfer Top, Straight Brace Chamfer Top, Curved Brace Finial, Cap Finial, Cap, Straight Brace Finial, Cap, Curved Brace Fluting, Crown Cap, Base Trim Top Mount, Fluting, Base trim Crown Cap Crown Cap, Curved Brace Crown Cap, Straight Brace Select Post Color Black White Gray Natural Select Post Size 4 x 4 5 x 5 6 x 6

Post Installation (local only): Where to install the new post Replace Existing Post Install at Customer Placed Marker Other- Contact me for details

Note: Aluminum and Keystone Deluxe posts are UPS shippable. Cedar posts are available for customer pickup or installation in our local area.

Cost

Use separate form for each mailbox ordered. (Call for quantity discounts.)

Mailbox Price Post Price Installation $125.00  (Available Fairfield County, CT and Westchester and Putnam County, NY) Subtotal Sales Tax (CT Addresses at 6%, NY at 8%) Shipping $15.00 Mailbox and/or Post East of Miss. River (All others call for quote.) Total (Required)

Billing Information

Purchaser:

Name: Address1: Address2: City: State:Zip:

Visa    MasterCard     Discover

Account:Exp. date:

Statement Address if Different from Above

Street/P.O.Box City: State:Zip:

Signature (FAX/mailed orders):__________________________________________

If you have any questions, comments, or special requests, enter them here.

To place this order

E-mail it by clicking on the submit order button.

OR

Print this page and FAX it to (203) 849-1155

OR

Print this page and telephone us at (203) 849-1144

Mr. Mailbox will confirm your order and advise you of a shipping or installation date. If you have any questions please feel free to contact us.   Thank you for your order.

Copyright 2003, Mr. Mailbox L.L.C. All Rights Reserved.