Mothman Merchandise Order Form
BOOK: Mothman: Behind the Red Eyes
Quantity:____ x $19.95 = $_________
BOOK: Mothman: Facts Behind the Legend
Quantity:____ x $19.95 = $_________
BOOK: Mothman Prophecies
Quantity:____ x $6.95 = $_________
BOOK: The Braxton County Monster
Quantity:____ x $23.95 = $_________
Mothman Coffee Mug
Quantity:____ x $12.00 = $_________
Adjustable Mothman Hat
Quantity:____ x $12.00 = $_________
Black Car T-Shirt
Quantity:____ Size(s)__________ x $18.99 = $_________
Gray Car T-Shirt
Quantity:____ Size(s)__________ x $18.99 = $_________
Bright Orange T-Shirt
Quantity:____ Size(s)__________ x $18.99 = $_________
Night Scene T-Shirt
Quantity:____ Size(s)__________ x $18.99 = $_________
40 Years T-Shirt
Quantity:____ Size(s)__________ x $18.99 = $_________
Button Set for Collectors
Quantity:____ x $8.00 = $_________
14" Mothman Plush Figure
Quantity:____ x $24.95 = $_________
MOTHMAN Bumper Sticker
Quantity:____ x $3.50 = $_________
Subtotal = $_________
SHIPPING & HANDLING (see chart below) = $_________
TOTAL AMOUNT OF ORDER = $_________
SHIPPING AND HANDLING CHARGES:
Orders up to $10.00: $2.95
$10.01 to $25.00: $3.95
$25.01 to $75.00: $5.95
$75.01 to $150.00: $7.95
Over $150.00: $9.95

Make check or money order payable to: MothmanLives.com

Mail order to: MothmanLives.com, 324 Main Street, Point Pleasant, WV 25550
 CREDIT CARD ORDERS

Name on card:_______________________________

Signature:___________________________________

Expiration:___________________________________

Visa/MC:____________________________________

Card Number:________________________________

Note: Your credit card statement will reflect a charge to CRIMINAL RECORDS, our online sales partner.
Ship this order to the following address (please include your phone number or e-mail so that we may contact you about your order if there is a problem; information is kept confidential):