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

Fax the Order Form w/ Credit Card Info to:

Shepherd Hills Factory Outlets
FAX: 417-532-6044

To order, call 1-800-727-4643