Colibri Men's Jewelry and Butane Lighters
Secure Electronic Order Form

Billing Information (must match exactly with information credit card company has on file):
*Required

- Name *
- Street Address *
- City *
- State/Province *
- Zip / Postal Code *
- Country *
- Day Phone No. *
- Night Phone No. *
- Fax Number
- E-Mail Address *

Shipping Information (if different from billing address - US only):

- Name
- Street Address
- City
- State/Province
- Zip/Postal Code
- Country
- Day Phone No.

Method of Payment:

Visa MasterCard American Express Discover
- Name on Card
- Account No.
- Expiration
- Bank Issuing Card

Items Ordered:

Item I
- Item No.
- Description
- Quantity
- Unit Price
- Item 1 Subtotal

Item 2
- Item No.
- Description
- Quantity
- Unit Price
- Item 2 Subtotal

Item 3
- Item No.
- Description
- Quantity
- Unit Price
- Item 3 Subtotal

Item 4
- Item No.
- Description
- Quantity
- Unit Price
- Item 4 Subtotal

Order Total
- Items 1 - 4 Subtotal
- Shipping, Handling and Insurance
- Sales Tax (Utah Residents Only - 6 3/8%)
- Order Total

Within the United States, add:
$ 8.95 for shipping, handling & insurance for orders up to $50.00.
$10.95 for shipping, handling & insurance for orders $51.00 to $100.00.
Add $ 2.00 for each additional $100. (USPS Priority Air Insured)
$24.00 - Express for orders up to $100.00. Add $5.00 for each $100.00.
     (Cannot ship lighters by Express Mail)

International, add:
Express Mail Insured - $36.00 for orders up to $100.00 for shipping, handling and insurance.
Add $5.00 for each additional $100.00. (allow 10 to 20 business days for delivery, depending on your customs)
May not be able to ship to some countries. Cannot ship lighters outside the U.S.

Please be sure an E-Mail Address and Phone Number is included on your order.
We use the United States Postal Service for all shipping.