LOOKOUT CARSEATS ORDER FORM

If paying by VISA or MasterCard, print this form, fill out, and fax to 301-762-6422. If you don't 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

If shipping to a different address, please note on order form or separate sheet of paper.

PRICES
Price includes ground shipping to locations east of Mississippi River. **If you live west of Miss. River, add $4 additional shipping for Regular (Small) Carseats; add $12 for Oversize (Med) and My Buddy (Extra Lg) Carseats. For HI, AK, or outside of US, contact Jill for shipping costs.
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 $3.25 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
Quant Item(specify CARSEAT/SIZE)
DRAWER? Yes/No
FABRIC
COST 
**ADD
SHIP
TOTAL
COST
             
             
             

Merchandise Total:   _________
6% Sales Tax (Maryland orders only): _________
Shipping (W of Miss River or Travel Racks & Attachment Straps shipped w/o carseat): ________

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