Secure Payment Form

Kulie Originals Order Form
You can fill out this form, print it and mail it,
Or you can call and place your order.

Kulie Originals
149 Willow Springs Road Tunis, MO. 65764-9152
417 345-6813

Please enter your details, fields marked with are required!**
Business Name (if applicable):
Contact Person**:
Phone Number:
Fax Number:
E-mail**:double check this entry
Delivery/Mail Address (Address, Zip etc):
Below please enter Cardholder's Address exactly as shown on Credit Card statement!
Cardholder's Name as on card**:
Street Address**:
City+Postcode**
Country**:
State/Province/County:
Zip**: Non-USA use 99999

If You reside In Missouri, State Tax of 7.225 % must be added to the sales amount.
If this applies to you please check the box

Sales Tax 7,225 % will be added to the sales total.

Shipping and Handling	AMOUNT
Shipping and Handling $6.50, basic order. If ordering mugs: for over 2 mugs add $1.00 per mug.