ORDER FORM
                               Send to : 820 Lk. Mendocino Dr.
                                     Ukiah, CA  95482


Shipping information


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


Number of additional Units

X $2.75 =


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

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