LOOKOUT CARSEATS ORDER FORM

If paying by VISA or MasterCard, print this form, fill out, and fax to 301-762-6422. If you do not have access to a fax machine, you may call in your order to 301-762-6022 between noon - 9 PM Eastern.
If paying by check or money order, print and complete this form and mail with payment. Make checks payable to MARYLAND BICHON FRISE RESCUE, INC. and mail to Jill Siegel / 13400 Valley Dr. / Rockville, MD 20850. Orders paid by personal check will be processed after check clears. 

Cardholder Name
Billing Address
City, State, ZIP
Daytime Phone
Email Address
Payment Method VISA ____ MasterCard ____ Check/Money Order ____
Card Number
Expiration Date (mm/yyyy)
CVV2/CVC2/CID
3-digit # on back of card

For a limited time, get free ground shipping to the continental US for carseats. 
If shipping to a different address, please provide on separate sheet.

PRICES
REGULAR (Small) Carseat, $74 (plus $6 for leopard).
REGULAR (Small) Carseat w/ drawer, $89 (plus $6 for leopard).
OVERSIZED (Med.) Carseat, $97 (plus $8 for leopard).
OVERSIZED (Med.) Carseat w/ drawer, $109 (plus $8 for leopard).
MY BUDDY (Extra Lg) Carseat (includes drawer), $136 (plus $10 for leopard).
TRAVEL RACK, $15.  No additional charge if shipped with carseat, otherwise add $8.50 for shipping.
ATTACHMENT STRAP, $10. No additional charge if shipped with carseat; otherwise add $2.00 for shipping.
(Note: 1 attachment strap comes with Regular & Oversized Carseats; 2 attachment straps with My Buddy)

FABRICS

Black Nylon Quilt
Khaki Nylon Quilt
Leopard Nylon Quilt
Silver Nylon Quilt

Azure Plaid
Blackwatch Plaid
Colonial Plaid
Highland Maize
O'Donnell Plaid
Denim

Black Soft Vinyl (faux leather)
Burgundy Soft Vinyl (faux leather)
Gray Soft Vinyl (faux leather)
Hot Pink Soft Vinyl (faux leather)
Khaki Soft Vinyl (faux leather)
Light Pink Soft Vinyl (faux leather)

ORDER 

ITEM TYPE
(specify CARSEAT/SIZE)
DRAWER? (Yes/No)
FABRIC COST  NUMBER
TOTAL
COST
           
           
           

Merchandise Total:   _________
6% Sales Tax (Maryland orders only): _________
Shipping (for Travel Racks & Attachment Straps shipped without carseat): ________

Total Payment:   __________ (Note: Payment must be in US dollars)

Special Instructions