Hays Internet Marketing, Inc.'s LipStore.com Order Form

This form is ONLY for USA orders. If you are outside the USA, contact us first for a shipping price before sending your money.

To send a check or money order in US FUNDS ONLY, print this page and then fill out the form and mail it with your check or money order to:

make checks payable to:
Hays Internet Marketing, Inc.
10675 E. Northwest Hwy #1655-675
Dallas, TX 75238

Quantity Item Description Unit Price Total Price
             
       
       
       
       
       
       
Sub-Total Price of Merchandise: ________
Live in Texas? add 8.25% sales tax: ________
Shipping: (see rate table) ________
Total amount DUE: ________
Shipping Rates:
your sub-total shipping fee
$0 - $2 $2.00
$3 - $10 $5.00
$11 - $20 $7.00
$21 - $50 $10.00
$51 - $100 $15.00
$101 - $500 $20.00
Lip Sofa $190.00


Shipping Address

Name: ________________________________________

Address: ______________________________________

Suite/Apt#: ____________________________________

City:_____________________ State: _______

Zip/Postal Code:_______

Day Phone: ______________E-mail:________________



For faster delivery, send us an e-mail before you order, so we'll be sure to set aside a pair of lips for you: email us


Billing Information

Name: ________________________________________

Address: ______________________________________

Suite/Apt#: ____________________________________

City:_____________________ State: _______

Zip/Postal Code:_______

Day Phone: ______________E-mail:________________

Questions or comments:
call: 214-221-9700

Hays Internet Marketing, Inc.
10675 E. Northwest Hwy #1655-675
Dallas, TX 75238