Patches Etc Order Form Template

Instructions:

Make sure your printer is turned on and has paper.

Select FILE in the top left of your browser window then select PRINT

QTY	Description	Price Each	Price Total
Patches Mail Order Form		337 South Main Street Saint Charles, MO 63301 Phone: (636) 946-6004 Toll Free: 1-877-522-2026 Fax: (636) 946-9141

		$	$
		$	$
		$	$
		$	$
		$	$
Subtotal			$
(See Shopping Help for Rate Info) Shipping & Handling			$
MO Residents Only - Add Sales Tax 7.450%			$
TOTAL			$

Over-write this message with any special instructions you may have for your order.

Billing and Shipping Information NO P.O. BOXES PLEASE
BILL TO:			SHIP TO: (Not required if same as BILL TO)
Name:			Name:
Address:			Address:
City:			City:
State:			State:
Province:			Province:
Country:			Country:
Zip/Post Code:	-		Zip/Post Code:	-
Phone No.:	- -		Phone No.:	- -
Email Address:

Credit Card Information
CREDIT CARD MasterCard Visa American Express	Name as it appears on Credit Card Signature: _____________________________
CREDIT CARD NUMBER - - -	Expiration Date Month: Year: