| NAME_______________________________________________________________________ |
| ADDRESS___________________________________________________________________ |
| CITY____________________________________________STATE_______ZIP_____________ |
| E-MAIL______________________________________________________________________ |
| PHONE_____________________________________________________________________ |
| |
ORDER
FORM |
| Quantity |
Code |
Description |
Item Price |
Total |
| _______ |
_____ |
_______________________________________ |
______________ |
______________ |
| _______ |
_____ |
_______________________________________ |
______________ |
______________ |
| _______ |
_____ |
_______________________________________ |
______________ |
______________ |
| _______ |
_____ |
_______________________________________ |
______________ |
______________ |
| _______ |
_____ |
_______________________________________ |
______________ |
______________ |
| _______ |
_____ |
_______________________________________ |
______________ |
______________ |
| _______ |
_____ |
_______________________________________ |
______________ |
______________ |
| |
|
|
SUBTOTAL |
______________ |
| |
|
(PA
residents add 6%) |
SALES
TAX |
______________ |
| |
|
(We
can not calculate shipping at order time. You will be contacted via
email or phone regarding shipping cost.) |
SHIPPING |
______________ |
| Please
allow 2 weeks for shipping after payment. (We will wait until your check
clears our bank before shipping your order.) You may order by phone (Monday
- Saturday between 10 AM and 4 PM) or by emailing the information on
this order form to birdinhandiron@paonline.com. |
AMT.
DUE |
______________ |
| |
|
| Indicate payment
choice: ____ Check ____ Visa/MasterCard |
|
|
Card Number
______________________________________
Expiration Date ____________________________________
Name on Card _____________________________________
Zip Code where statement is mailed: ____________________
Date: ____________________________________________
Signature _________________________________________ |
|
|
