Brisker Order Form
(Just 3 easy steps, and fully secured)

Step 1:  What would you like?

                             Brisker Originals                           Or                       Brisker Juniors
                      Order 3 and the third is FREE!                                           Order 4, and the 4th is FREE!
                     

 

 

*FedEx Ground 1-4 day service within the Continental U.S.
Please allow two weeks for delivery.
Shipments to Canada add $20 per unit
Shipments to HI, VI, PR and Cayman Islands add $40 per unit
Add 7% sales tax for Ohio shipments only
Free Brisker(s) must be shipped to the same address

 

 

 


 

 


                   Brisker Replacement Handles                                Brisker Upgrade Magnetic Stripping 

Qty. Handles Shipping Total
1 $4.95 $5.95 $10.90
2 $8.95 $5.95 $14.90
3 $11.95 $5.95 $17.90
4 $13.95 $5.95 $19.90
Qty. Strips Shipping Total
1 $2.95 $4.95 $7.90
2 $7.95 $4.95 $12.90
3 $10.95 $4.95 $15.90
4 $12.95 $4.95 $17.90

 

 

 

 

 

Step 2:  Where do you live?

Billing Information:                                                               Shipping Information (If Different):

First Name:    First Name:
Last Name:    Last Name:
Address:     Address:
City, ST  Zip: ,               City, ST  Zip: ,    
Phone Number: Phone Number:
Email:    Will this be a gift for someone else?
  Gift Note?:  
Qty. Originals Shipping* Total
1 $89.95 $9.95 $99.90
2 $179.90 $19.90 $199.80
3 $179.98 $29.85 $209.75
4 $269.85 $39.80 $309.65
5 $359.80 $49.75 $409.55
6 $359.80 $59.70 $419.50
Qty. Juniors Shipping* Total
1 $79.95 $7.95 $87.90
2 $159.90 $15.90 $175.80
3 $239.85 $23.85 $263.70
4 $239.85 $31.80 $271.65

 

Step 3:  How would you like to pay?

Which credit card would you like to use?         
Card Number?        Expiration Date?   
Name on Card?   

                              
Copyright © 2005 Brisker Products.  All rights reserved.
Revised: 01/04/10