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
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Item Number |
Description / Title |
Price per Unit |
Number of Units |
Total Cost |
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Total Cost = |
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California Residents Please add 7.0% sales tax |
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Shipping and Handing Charges First unit |
$4.65 |
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Number of additional Units |
X $2.75 = |
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Total Amount of Payment to Include with order = |
$ |
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Personal checks must clear bank before shipping will be done. |
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Make money orders and checks payable to; --- D. Smith |
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