Order Form
Customer Name: ___________________________
Address:__________________________________
_________________________________________
City: _____________________________________
State _____________ Zip: ___________________
Phone: (______) ___________________________
E-mail: __________________________________
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QTY. |
ITEM # |
DESCRIPTION OF ITEM |
PRICE
EACH |
TOTAL
PRICE |
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Merchandise Total |
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Shipping (
$ 6.00 for
first item, 50 ¢ each addt'l item) |
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MO Residents add 7.413 %
sales tax
KY Residents add 6% sales tax
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Method Of Payment:
______Check Account Number: ___________________________________
______Money Order
______Visa Exp. Date: _______________
______Master Card Signature:_________________________________________
______Discover Please Print Name: __________________________________