Lost Angeles Rubber Works Order Form
Pmb #403, 8306 Wilshire Blvd., Beverly Hills CA 90211 USA

Fax: (310) 943-2167

Date :



City, State, & Zip:

Email Address:

(Mastercard/Visa/American Express orders) Card # :___________________________________________________________

Expiration Date and CVV2 #:____________________________________________________________________________
(CVV2 number is a 3- or 4- digit number on the back of the card, right after the credit card number)

(Please circle) Mastercard? Visa? AmEx? Signature:__________________________________________________________

Name as it appears on credit card:_________________________________________________________________________

Phone (required for credit card orders)______________________________________________________________________

Items desired: Please write down quantity, item number, description, & price

Price codes (for our stamps)- AA:$6.75, A:$7.25, B:$8.00, C:$8.75, D:$9.50, E:$10.25, F:$10.90, G:$13.00, H:$15.50, I:$17.80, J:$19.95, K:$22.95
Unmounted prices - AA: $2.70, A:$3.05, B:$3.50, C:$3.95, D:$4.50, E:$5.00, F:$5.45, G:$6.50, H:$7.75, I:$8.90, J:$9.95, K:$11.40
Additional catalog packs (including ASLstamp catalog and main catalog) are $5.95 each, partial refund ($8.00 outside USA). .Supplement is available N/C for a LSASE or 2 International Reply coupons.

Please (very carefully) add up prices to get the subtotal. _______________________________

California resident? Figure your sales tax here____________________________________________
(either your tax rate or 9.25%, or see ordering info page)

Add shipping here (if you forget, we'll add it for you)_______________________________________
(for U.S. retail orders under $25, shipping is $5.50; $25-50 is $6.95; $50-100 is $8.95; over $100 is $10.95. Other countries are higher -- please see ordering info page. Check/MO orders with insufficient shipping may be delayed.)

Add up for total (please figure very carefully) ____________________________________________

Please make checks/money orders payable to Lost Angeles Rubber Works.
Please allow 4-6 weeks for delivery in the U.S. (but we usually move faster than that!)
Any questions? Please see (you guessed it) the ordering info page or email
Need more space? Just write on the back of this form.
For help, please email

THANK YOU! for ordering (and printing legibly).