| Sold
To: |
Ship
To: (If different) |
| Name: |
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| Address: |
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| Tel: |
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| Fax: |
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| E-mail: |
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| |
| |
Style/Size/Color |
Unit
Price |
Quantity |
Amount |
1. |
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2. |
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3. |
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4. |
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5. |
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6. |
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7. |
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8. |
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9. |
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10. |
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| Payment
Type ----- Salesperson: ________ |
Subtotal |
|
| Visa____MC___Cash___Ck#___________ |
Tax
(8.25%) CA Residents Only |
|
| Card
#: _____________________ |
Exp:
____________ |
Shipping
& Handling |
|
| Cardholder
Name (Print): __________________________________ |
TOTAL |
|
| Cardholder
Signature: ___________________ Date: __________ |
