Order Form

Customer Name: ___________________________

Address:__________________________________

_________________________________________

City: _____________________________________

State _____________ Zip: ___________________

Phone: (______) ___________________________

E-mail: __________________________________

QTY.

ITEM #

DESCRIPTION OF ITEM

PRICE
EACH

TOTAL
PRICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Merchandise Total   

 

Shipping ( $ 6.00 for first item, 50 each addt'l item)  

 

MO Residents add 7.225 % sales tax   
KY Residents add 6% sales tax
   

 

 

Total  

 

Method Of Payment:
______Check                     Account Number: ___________________________________
______Money Order
______Visa                          Exp. Date: _______________
______Master Card             Signature:_________________________________________
______Discover                Please Print Name: __________________________________

Mail the Order Form W/ Payment to:

Shepherd Hills Factory Outlets
P.O. Box 909
Lebanon, MO 65536-0909

OR

Fax the Order Form w/ Credit Card Info to:

Shepherd Hills Factory Outlets
FAX: 417-532-6044

OR

To order, call 1-800-727-4643