ORDER FORM
Print this page, fill out order form and mail or fax to:
WILDLIFE
INTARSIA DESIGNS
by
Robert J. Hlavacek, Sr.
P.O. Box 1246 - North Riverside, IL 60546-0646
Phone: 708-788-6455 - FAX: 708-788-1215
|
NAME ________________________________________ PHONE # _______________ ADDRESS ________________________________________________________________ CITY ________________________ STATE ___________ ZIP ____________ DATE ________________________ FIRST TIME ORDERING? ____ YES ____ NO |
| QTY. | ITEM # | DESCRIPTION | PRICE EACH | TOTAL |
|
SHIPPING & HANDLING: U.S. $2.00 - CANADA $3.00 - FOREIGN $9.00 PER ORDER. Personal checks for U.S. orders welcome. All orders from outside U.S.A. - If order is not charged on VISA or MasterCard, payment must be by international money order, in U.S. funds payable to: Chairman of the Board. |
ORDER TOTAL | |||
| IL Residents Only Add 10% State Sales Tax | ||||
| Shipping & Handling | ||||
| Total Payment Due | ||||
CHECK ONE: ______ VISA _______ MASTERCARD
EXP. DATE SIGNATURE _________________________________
Send to: Robert J. Hlavacek, Sr. -W
P.O. Box 1246
North Riverside, IL 60546-0646