Order Form

Item Description Quantity Cost

_____________________________________________________

Order Sub-Total: $___________

Shipping and Handling: $___________

If Order Sub-Total is…

$ 0 - $10.00 Add $5.95

$10.01 - $20.00 Add $6.95

$20.01 - $40.00 Add $7.95

$40.01 - $75.00 Add $8.95

$75 > /International Add $16.95

Your Total $___________

Method of Payment:

___ Visa ___ Mastercard ___ Check/Money Order

Credit Card Number _____ _____ _____ _____

Expiration Date _____/__________

Shipping Information:

Name: _______________________________________

Address: _______________________________________

_______________________________________

Phone: (________) _________ - __________________

PRINT THIS OUT AND MAIL TO:

Jesse James Museum

21216 Jesse James Road

Kearney, MO 64060

Phone: 816.628.6065

Fax: 816.628.6678

claycogov.com

jessejames.org