Mail Order Form

We-Exist-Store.com
Gift Shop for the Busy Executive

MAIL ORDER FORM
sales@we-exist-store.com

Check Payable to:
Brobst Systems, Inc.
P.O. Box 262041
San Diego, CA 92196

Bill To: Ship To:

Name:	.	Name:	.
Address:	.	Address:	.
City, State ZIP:	.	City, State ZIP:	.
e-mail:		e-mail:
Phone:	( )	Phone:	( )
Fax:	( )

Order:

Item #	Item Description (include any options, etc.)	Manufacturer	Qty.	Price	Extended
				$	$











		Subtotal			$
		Plus CA Sales Tax			$
		Plus Shipping & Handling			$
		Total			$

Shipping & Handling Chart:
These charges represent only a part of the actual costs. We'll pay the
rest.

If your order is:
up to $30.00	add $10.45
from $30.01 to $39.99	add $10.95
from $40.00 to $54.99	add $11.45
from $55.00 to $74.99	add $13.45
from $75.00 to $99.99	add $14.95
$100.00 or over	FREE

California Residents will be assessed a Sales Tax
The CA sales tax is 7.75% and will be calculated based on which state the
item will be shipped.

Payment Info:

Note: These are the only forms of payment we accept.

			Or pay by Personal Check Please make your check payable to "Brobst Systems, Inc."

------------------------------------------------ Card Number -------------------------------------------

Exp

Credit Card V-Code:

For your security, and for credit card fraud prevention, we require the V-Code on your credit card. This number is separate from your regular card number and only appears on your card. Visa, MasterCard, and Discover card holders should flip your card over. You will see your 16 digit card number followed by another 3 digits. This is your V-Code.

_______________________________________________
Signature of Cardholder…must match "Bill To" name above.

I authorize We-Exist-Store.com to charge the credit card number indicated above for the total above plus sales tax (if applicable). I certify that the credit card number and signature above agree to the "Bill To" name above and that, as such, I am an authorized signer on this card.