Local Mall Offline Order Form
To be used only if paying by cash, check, or money order

Fill-in Form and Then Print

Text Box: Shipping and Handling Subtotal Under $45.00 $45.00 to $54.99 $55.00 to $74.99 $75.00 to $99.99 Over $100 Charge $5.00 $8.00 $9.00 $10.00 10% of Subtotal

Item #    Description    Unit Price  Qty Line Total
Subtotal 
Taxes - CA Residents Only (Subtotal X 0.0975)   
Shipping and Handling (See Chart Below)    
Order Total   

 

Name:        
Address:        
City:

State:

Zip:

 

 

  
Country:        
Phone:        
E-mail:        
Payment Method Cash     Check     Money Order

Allow 4 to 6 weeks for delivery

If  paying by money order,  make out to CORONEL DATA PROCESSING

Mail Printed Order Form and Payment to:

CORONEL DATA PROCESSING
c/o Mall Order
23535 Palomino Dr., #253
Diamond Bar, CA 91765