JESSIE'S
ORDER FORM
Send to : 820 Lk. Mendocino Dr.
Ukiah, CA 95482
Date_________________
Shipping information
Name________________________________________________
Address ______________________________________________ Apt # __________________
City__________________________________________________ State______ Zip________________
Telephone Number (____) ______________________________ Email _________________________
Product Order
|
Item Number |
Description / Title |
Price per Unit |
Number of Units |
Total Cost |
|||
|
|
|
|
| |||
|
|
|
|
| |||
|
|
|
|
|
|||
|
|
|
|
|
|||
|
|
|
|
|
|||
|
|
|
|
|
|||
|
Total Cost = |
|
||||||
|
California Residents Please add 7.0% sales tax |
|
||||||
|
Shipping and Handing Charges First unit |
$4.85 |
||||||
|
Number of additional Units |
X $2.95 = |
|
|||||
|
Total Amount of Payment to Include with order = |
$ |
||||||
|
Personal checks must clear bank before shipping will be done. |
|||||||
|
Make money orders and checks payable to; --- D. Smith |
|||||||