Microcosm Publishing Order Form

Chart 1 - Zines, Books, T-Shirts, DVD's, CD's, & Posters

Quantity

Description & Size (if applicable)

Cost/Item

Weight/Item

Total Cost

Total Weight

$ oz $ oz
$ oz $ oz
$ oz $ oz
$ oz $ oz
$ oz $ oz
$ oz $ oz
$ oz $ oz
$ oz $ oz
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Chart 1 Total Cost
$ oz
Chart 1 Total Weight
oz

Chart 2 - Patches, Buttons and Stickers only!

Quantity

Description

Cost/Item

Total Cost

Weights

$ $ Poster: 1oz T-Shirt: 9oz
$ $ CD: 4oz DVD: 5 oz
Chart 2 Total Cost ->
<- Chart 2 Total Qty
$ Sticker: .05oz Pin/Patch: .1oz

Name:

CHECKOUT

Street Address:
Chart 1 Total Cost:
$
City, State & Zip:
Chart 2 Total Cost:
$
TOTAL ITEMS COST:
$
Email:

SHIPPING

Comments:
Chart 1 Shipping Cost:
$
Chart 2 Shipping Cost:
$
Insurance:
Y / N

Send well concealed cash (wrapped in two sheets of paper), check, or money order to: Microcosm - 2752 N Williams Ave. Portland OR 97227. You can alternatively fill out your credit card information below.

FINAL COST:
$

ALTERNATES

CREDIT CARD FORM

Quantity Description & Size (if applicable) Account #:
CVV Code (3 digits on back upper right hand side)
Name:
Expires:

SHIPPING RATES (Circle your type of shipping)

1st class (approx. 2-5 days)
up to 5oz $2.65
5oz up to 8oz $3.50
8oz up to 10oz $4.00
10oz up to 13oz $4.50
13oz $5.00

Priority (approx. 2-3 days)
up to 49oz $5.69
49oz up to 80oz $11.38
over 80oz: $11.38 + $5.69 per 32oz

Media (approx. 3 days - 3 wks)
up to 17oz $2.50
17oz up to 33oz $3.00
33oz up to 49oz $3.50
49oz up to 61oz $4.00
61oz up to 77oz $4.50
77oz up to 92oz $5.00
over 92oz $5.50 + $.50 per 16oz
MEDIA MAIL FOR BOOKS, ZINES, VIDEOS ONLY. No shirts, patches, buttons, or stickers.

International (approx. 3-6 days)
up to 7oz $6.65
7oz up to 33oz $10.65
over 33oz $10.65 + $10.65 every 32oz

Canadian (approx. 4-10 days)
up to 5oz $2.50
5oz up to 7oz $3.00
7oz up to 9oz $3.75
9oz up to 12oz $4.25
12oz up to 17oz $5.00
17oz up to 21oz $5.75
21oz up to 25oz $6.50
25oz up to 29oz $7.00
29oz up to 32oz $7.75
32oz up to 64oz $8.50
over 64oz $8.50 + $8.00 every 32oz