ORDERED BY: SHIP TO:
Same as "Ordered By"
Name:______________________________________ Name:______________________________________
Address:___________________________________ Address:___________________________________
___________________________________________ ___________________________________________
City:______________________________________ City:______________________________________
State/Province:__________________Zip:______ State/Province:__________________Zip:______
Country:___________________________________ Country:___________________________________
Daytime Phone: ____________________________ Send as a gift from: ______________________
Evening Phone: ____________________________ With message:______________________________
E-mail Address: ___________________________ ___________________________________________
| ITEM # | SIZE | QUANTITY | DESCRIPTION | PRICE | TOTAL |
|---|---|---|---|---|---|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
| Subtotal | |
||||
| In CA, add appropriate Sales Tax: | |
||||
| Shipping, Packing, and Handling (See chart for proper rates) |
|
||||
| Total | |
||||