Mark Sosin's
Saltwater Journal Order Form
Please print clearly; mail or fax this form to:

Maritime Mercantile, Inc. 681 S.W.15th Street,
Boca Raton, Florida 33486-7039
FAX (561) 391-3004

QTY. PRODUCT
CODE		 OPTIONS DESCRIPTION   PRICE   EXT.
     PRICE     
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
SUB-TOTAL   
For U.S. orders only: Shipping & Handling (see chart below)   
Florida orders: Add 6.5% Sales Tax   
Foreign order handling fee: $5.00 - Actual shipping cost will be added to total.   
TOTAL   
Packing, Shipping & Insurance - For orders within U.S. only
Under $25.00 $25.01 - 50.00 $50.01 - 75.00 $75.01 - 100.00 $100.01 - 150.00 $150.01 or more
$3.95 $4.95 $5.95 $6.95 $8.95 Free shipping
Canada, Mexico and all foreign orders are shipped at actual shipping cost
plus a $5.00 handling fee, VISA or MasterCard only. No checks please. 
Ship to:

Name:______________________________________________________ Phone:________________________

Address:___________________________________________________ e-mail:_______________________

City:__________________________ State:______ Zip:_____________ Country:___________________


Payment method: (Choose one)

A. ___Check enclosed    ... or ...   
B. Charge to:  ___VISA    ___MasterCard

  Account No:_____________________________________________________ Exp. Date: ____________

  Name on Card:_____________________________ Signature:___________________________________