This order form is secure. It is encrypted
during transmission using Secure Socket Layer(SSL) technology
so you can safely use your credit card.

To place an order...
simply fill out and submit the following form, even if you are paying by check or money order.  If you prefer to fax your order, you can print out the form and fax to 610-942-0137.  (Checks Payable to Country Lane Products)  Thank you.

How did you hear about us?

BILLING INFORMATION
   
SHIPPING INFORMATION
ONLY if different from billing address. ADD $1.50
to Shipping Cost if Drop Shipping to someone else
Name
Company
Address
Address
City
State Zip
Country
Name
Company
Address
Address
City
State Zip
Country
CONTACT INFORMATION
Phone Number with Area Code Fax Number (if applicable)
E-mail Address

Ordering Instructions:

Our service offers custom engraving on each item, but the number of lines and letters are limited by space and cost considerations.  On some items, 3 lines can fit nicely, while other items have more limited space.  IF YOU WOULD LIKE TO ORDER MORE THAN 5 ITEMS, please summarize on the online order form and send a separate e-mail with the copy for each item.  We will acknowledge when we get everything.

For each item, our website details the standard amount of engraving.  If you would like more than the standard amount, you must use the line in the form below called "Additional Line". Please note that the added cost is 20 cents per letter. (See individual items for standard amount of engraving)

For CUSTOM SIZE NAMEPLATES, please use "Custom" for item and refer to our CUSTOM SIZE NAMEPLATES page to determine pricing and all available options.

PLEASE NOTE: All Engraving will be Centered unless otherwise specified in the comments section.

ITEM # ENGRAVING
STYLE
DESCRIPTION
OF PRODUCT
COST
PER ITEM
HOW
MANY?
ITEM
TOTAL COST
Engraving Line 1        
Engraving Line 2        
Engraving Line 3        
Additional Line @$0.20/letter
 
Engraving Line 1        
Engraving Line 2        
Engraving Line 3        
Additional Line @$0.20/letter
 
Engraving Line 1        
Engraving Line 2        
Engraving Line 3        
Additional Line @$0.20/letter
 
Engraving Line 1        
Engraving Line 2        
Engraving Line 3        
Additional Line @$0.20/letter
 
Engraving Line 1        
Engraving Line 2        
Engraving Line 3        
Additional Line @$0.20/letter
 
Order Total  
(Please ADD $1.50 to the regular shipping charges when drop shipping to someone else) * Shipping  
Subtotal  
PA Residents Add 6% Sales Tax  
Total Cost  

* Shipping Costs: (US only)
Purchase     Shipping
$0 - $35.00 $5.75
$35.01 - $50.00 $6.50
$50.01 - $75.00 $7.50
$75.01 - $125.00 $9.00
$125.01 - $250.00 $12.00
$250.01 - $350.00 $15.00
$350.01 - $500.00 $18.00
Over $500.00 Special Quote

All orders ship via US Priority Mail unless other methods are requested and quoted.

PAYMENT INFORMATION
Select Payment Method Cardholder's Name Credit Card Number Expiration 3 or 4 Digit CCV Number (Required)

   (Please check accuracy of credit card number before submitting order)

For check or money order payments, please Send to & Payable to:

Country Lane Products
PO Box 852, Exton, PA 19341
or fax your order to:
610-942-0137

Before you submit - - Please be sure information is correct and complete.
The most common error is an incorrect credit card number and/or Exp. date.
IF YOU WOULD LIKE A COPY OF YOUR ORDER, please print this page before you submit it.

Note: Please be patient.  This form may take a minute or two to submit.  A "Thank You" page will appear when it has been successfully submitted.
YOU WILL ALSO RECEIVE a personalized e-mail acknowledgement of your order indicating lead-time and any questions we might have.

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