121 / 124
VII
NAME
MAILINGADDRESS
SHIPPINGADDRESS
CITY
DATE
TELEPHONE NUMBER
SHIPPING
TOTAL
UNIT PRICE
DESCRIPTION OF ITEM
ORDER #
QUANTITY
TOTALWT.
IN POUNDS
TOTAL
lbs
.
oz.
lbs.
oz.
TOTALAMOUNT
AMOUNT FOR
SHIPPING/HANDLING
CARESIDENTSADD
7.5% SALES TAX
ADD $2.00 FEE ON
ORDERS UNDER $20.00
TOTAL FOR GOODS
2620 W Main St, Barstow, CA 92311
PHONE: (800) 253-2954 USA
(760) 255-1030 International
CUSTOMER ORDER BLANK
PLEASE INDICATE MANNER OF PAYMENT BELOW
CARD #
EXPIRATION DATE
CARD HOLDER'S
SIGNATURE
FAX:
(760) 255-1077
7/13
CHECK
❒
VISA
❒
MASTER CARD
❒
DISCOVER
❒
AMEX
❒
STATE
ZIP