Pirates Territory printable order form

To Order our merchandise:

Print out this order form!!!
Complete our order form and mail or fax the form back to us.
Mail in your orders by Money Order, Cashier's Check, check (all checks are held for 14 days before orders are processed), Visa, M/C, Discover or American Express.
Make check or Money Orders payable to : Reilly's Treasured Gold, Inc.
Fax your order to us with the credit card information filled out to 1-954-971-0575, our fax machine is on 24 hours a day.
All International orders should be called in or faxed in with a credit card.
Send your orders to our mailing address at:

Reilly's Treasured Gold, Inc.
2003 West McNab Road #10
Pompano Beach, Florida 33069
Phone # 1-954-971-6102
Fax # 1-954-971-0575
All orders over $200.00 free shipping in the U.S. only!!! (48 states only)

First Name:_______________________ Last Name:_________________________

E-mail address: (if any)_________________________________

Shipping Address:___________________________________________________________

City, State, Zip______________________________________________________

Telephone:_________________________________________________________

Fax, If any:_________________________________________________________

We need a street address to ship your orders by U.P.S.
If shipping to a different address, send both addresses too.
Item No. - quantity - Item and Description - Our Price:

______ - _____-__________________________________-___________

-----------------------------------------------------------------------------------------------

SubTotal - ______________________________________-__________

6% tax (FLORIDA residents only)_____________________-__________

Add (see chart) for shipping & handling in U.S. only __________-___________

Add $9.00 for s&h for all orders up to $35.00
Add $14.00 for s&h for all orders from $35.01 to $70.00
Add $20.00 for s&h for all orders from $70.01 to $199.99
Free s&h on all orders over $200.00 in U.S. only! (48 states only)

Total Enclosed_____________________________________-__________

Shipping & Handling on all International orders are shipped by U.S. Postal Service & are billed by a credit card number.

Please charge to my Visa Card:_____
Please charge to my Master Card:_____
Please charge to my American Express:_____
Please charge to my Discover Card:_____
Name on the credit card:___________________________________________
Credit Card number:______________________________________________
Expiration date:__________________________________________________
cvv2 # on back of your credit card where you sign: _______________
Signature:______________________________________________________
Card Bank Name_________________________________________________

rtgsales@rtgstore.com

Please allow three to seven working days for delivery depending on where you live.
THANK YOU FOR SHOPPING AT REILLY'S TREASURED GOLD, INC.
this site known as Pirates Territory

Store Hours:
Tuesday to Friday 11:30 - 6:30 PM EST.
Saturday 11:30 to 4PM EST.
Closed Sundays & Mondays