To place an order, print
out this order form ,
fill it out and send it with payment, to the address below.
If you have any questions, please feel free to call us at
(503) 224 - 8259.
ORDER SHEET
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Description Item
# Size Color Qty. Price Total
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SUBTOTAL= --------------------
SHIPPING= ---------------------
TOTAL= ---------------------
Shipping Rates U.S.
$00.00- $25.00 = $ 5.95
$25.01- $50.00 = $ 6.95
$50.01- $100.00 = $10.00
$100.01-150.00 = $15.00
over $151.00 email for price
* Shoes are $10 shipping per pair
Please email for
Worldwide
POSTAL RATES
DO NOT forget your name,
address & contact info
including either phone or e-mail
in case we need
to contact you about your order!
Make Check or Money
Order payable to :
Another State of Mind
222 W. Burnside Street
Portland, OR 97209-3915
(503) 224-8259
Visa & MasterCard information
Name:_______________________________________
Address:_____________________________________
Card #_______________________________________
Expiration date_______________________________
Signature ____________________________________
Billing address for card if it differs from shipping address
______________________________________