LOOKOUT CARSEATS ORDER FORM

PRINT this form, fill out, and mail with check or money order, or fax to 301-762-6422 if using PAYPAL.  For PAYPAL, use the Visa/MC button on the Lookout Carseats information page.  Orders paid by personal check will be processed after check clears.  Make checks payable to MARYLAND BICHON FRISE RESCUE, INC. and mail to Jill Siegel / 13400 Valley Dr. / Rockville MD 20850.

Name
Street Address
Address (cont.)
City, State, ZIP
Country
Phone
E-mail

For a limited time,get free ground shipping to the continental US for carseats. 

PRICES

REGULAR (Small) Carseat, $74 (plus $6 for leopard).
REGULAR (Small) Carseat w/ drawer, $86 (plus $6 for leopard).
OVERSIZED (Med.) Carseat, $95 (plus $8 for leopard).
OVERSIZED (Med.) Carseat w/ drawer, $105 (plus $8 for leopard).
MY BUDDY (Extra Lg) Carseat (includes drawer), $130 (plus $10 for leopard).
Travel Rack, $15.  No additional charge if shipped with carseat, otherwise add $7.50 for shipping.

FABRICS

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

Azure Plaid
Blackwatch Plaid
Brown Mist
Colonial Plaid
Highland Maize
O'Donnell Plaid
Stewart Plaid

Black Soft Vinyl (faux leather)
Burgundy Soft Vinyl (faux leather)
Camel 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
(indicate RACK or CARSEAT/SIZE)		 DRAWER?
(Yes/No)
FABRIC COST  NUMBER TOTAL
COST
           
           
           

Merchandise Total:   _________
Sales Tax (5% of Merchandise Total, Maryland orders only): _________
Shipping ($7.50 for Travel Racks shipped without carseat): ________

Total Payment:   ________

Special Instructions