To place an order, print out this order form , fill it out and send it with payment, to the address below.
 If you have any questions, please feel free to call us at
(503) 224 - 8259.

ORDER SHEET
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Description              Item #                           Size            Color            Qty.           Price            Total
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                                                                                                        SUBTOTAL= --------------------

                                                                                                         SHIPPING= ---------------------

                                                                                                             TOTAL=  ---------------------

Shipping Rates U.S.
$00.00- $25.00   = $ 5.95
$25.01- $50.00   = $ 6.95
$50.01- $100.00 = $10.00
$100.01-150.00  = $15.00
over $151.00 email for price

Please email for
Worldwide
POSTAL RATES

DO NOT forget your name, address & contact info
including either phone or e-mail
in case we need to contact you about your order!

Make Check or Money Order payable to :
Another State of Mind
222 W. Burnside Street
Portland, OR   97209-3915

(503) 224-8259

  Visa & MasterCard information

Name:_______________________________________

Address:_____________________________________

Card #_______________________________________

Expiration date_______________________________

Signature ____________________________________

Billing address for card if it differs from shipping address

______________________________________