14015 W Co
Rd 578, Goodland, MN 55742
(218) 492-4487 email
M'lou
Please
print out this order form
and mail it with your check
or bankcard number,
or phone in your order.
To order online, click
HERE
| Ordered by: | Send to: |
| Name _______________________________ | Name ________________________________ |
| Address _____________________________ | Address ______________________________ |
| City ________________________________ | City _________________________________ |
| Phone ______________________________ | Phone _______________________________ |
| Email ______________________________ | Email ________________________________ |
|
How many?
|
Name
of design
|
Stock
number
|
Price
each
|
Total
|
|
Total for
merchandise
|
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|
MN residents
add sales tax
|
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|
Shipping and handling -
$100. and under, $4.00
over $100 - please add $1.00 per additional $100.00 |
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|
Total enclosed |
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Checks, Postal Money Orders, Discover, Amex, MasterCard and Visa are welcome.
Your Bankcard number:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ exp: _ _ /_ _
Last three numbers on the back of the card near the signature block. _ _ _
Your signature_______________________________________________
| M'Lou
Brubaker Home Page |