Personal Information:

Shipping/Billing Address:

Shipping Information is required if not the same as Billing Information

Order Information

How many would you like? 🛈
Order Total:            Shipping Cost:
$  0.00 - $ 80.00       $ 7.99 
$ 80.01 - $140.00       $10.99
$140.01 - $200.00       $14.99
$200.01 - $400.00       $19.99 
$400.01 +                    6% of sale price before tax

Credit Card Information

Important Information - Please Read

Sales Taxes is based on your Shipping Address.  You will receive and Order Confirmation from Shelf Reliance and a Shipping Confirmation, when ready, from Shelf Reliance.

Please know that I do not keep credit card information.  Once your order has been entered your informations will be deleted.  When you order next time I will need your credit card information again.

You will receive a confirmation email from  If you do not see that email in your inbox within 24 hours please check your SPAM folder.  I may have questions regarding the information on your form and if your phone # is not correct or my email does not arrive I can not process.

If you do not receive my email within 24 hours please feel free to email or call Francesca at 805-813-1265.  Thank you.
Powered byFormsiteReport abuse