|
Order Form |
|
Date of Order: ____________________________
Ordered by: Ship to:
|
|
_______________________________________ Name _______________________________________ Address Line #1 _______________________________________ Address Line #2 _______________________________________ City State Zip |
|
_______________________________________ Name _______________________________________ Address Line #1 _______________________________________ Address Line #2 _______________________________________ City State Zip |
|
Please indicate how you would prefer us to contact you for questions and info about your order [We will not share your information]: Best time [ ] E-mail: ____________________________ [ ] Phone: _______________ to call: ____________ |
|
Quantity Item # Size Description Unit Price Total |
|
Thank you for your order! If you have any questions, please do not hesitate to call or send an e-mail. |
|
Your purchase may be charged to your VISA or Mastercard. Please furnish the following info: [ ] VISA [ ] MasterCard Card #: ____________________________ Exp. Date: ________ 3 digit code on back of card: _________ |
|
If you would like to send a check as payment, please make it payable to Nancy Brown, and mail to the address shown below. Call for shipping charges to be added to your total order. |
|
Balance Due |
|
Shipping * |
|
* Shipping added at actual cost |
|
Subtotal |