5900 North Meadows Drive, Grove City, Ohio 43123-8476
Method of Payment
Banana Republic Card
Visa
Check or Money Order
American Express
Discover/Novus
Certificate
US dollars only (no COD)
MasterCard
JCB
credit card account number
exp. date
cardholder's signature
please print name
Gift
shipment? We'll notify the gift recipient and send you a confirmation.
gift message
Please provide your billing address:
Ms. Mrs. Mr.
please print
first name
middle initial
last name
street address
apt or suite
city
state
zip
(
)
-
(
)
-
(
)
-
day phone
evening phone
fax
e-mail address
We can deliver to your work address or to any other address. Please ship to:
Ms. Mrs. Mr.
please print first name
middle initial last name
street address
apt or suite
city
state zip
source
#
customer
#
GiftCard
or Online Gift Certificate
item no.
color:
1st choice
color:
alternative
size
pant only:
inseam
length
item name
quantity:
set equals
1 qty.
gift wrap
service
unit or
set price
total
price
Merchandise subtotal
prices are subject to change
Shipping and handling charge
all orders (see table at left)
Express delivery. Add $10
Saturday delivery. Add $15
Sunday delivery. Add $25
Canada delivery. Add $5
International delivery. Add $30
Each additional shipping address. Add $2
gift
Premium
wrap service. Add $5 each
Sales tax
see tax info box at left
Total amount enclosed
Shipping & Handling Charges
ORDER TOTAL
S&H
up to $25.00
$5.95
$25.01-50.00 $7.95
$50.01-75.00
$8.95
$75.01-100.00
$10.95
$100.01-150.00
$12.95
$150.01-200.00
$13.95
$200.01 and up
$15.95
SPECIAL DELIVERY OPTIONS
Express Delivery Upcharge
$10
4:30 pm delivery Mon.-Fri. order must be placed by 5 pm EST
Saturday Delivery Upcharge
$15
order must be placed by 5 pm EST on Fri.
Sunday Delivery Upcharge
$25
order must be placed by 12 noon EST on Sat.
Canada Delivery Upcharge
$5
International Delivery Upcharge
$30
for internal use only
Please add all applicable taxes to your order based on the delivery address (US only).
For assistance with calculating sales tax, please call 1.888.277.8953. Sales tax is charged on the merchandise total plus shipping
and handling charges for orders delivered to: AL, AZ, AR, CA, CO, CT, DC, FL, GA, HI, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI,
MN, MS, MO, NE, NV, NM, NY, NC, ND, OH, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY
Banana Republic Direct, Inc. W1 2002
Sales Tax Information
Please do not mail in your GiftCard.
Enter GiftCard or Online Gift Certificate number:
Enter PIN number:
CALL US TOLL FREE
1.888.277.8953
ANYTIME
FAX US
1.888.906.2465
WWW.BANANAREPUBLIC.COM
