Name:____________________________________ Ship to  Name:______________________________
Address:__________________________________       Address:________________________________
_________________________________________        ______________________________________
City:_______________ State:_______ Zip:________       City:_____________ State:_____ Zip:_________
Phone:___________________       
e-mail:__________________________________  
Quantity Description Size Price/Item Total
         
         
         
         
         
         
         
         
         
         
         
Sub Total:   
10% discount if you ordered 12 or more items.  
Shipping: see below  
Total:  
Rates below are for reference only. Contact us for actualy shipping on each item to fill into this form.
Total: Shipping West of Rockies  
0-$10.00 $5.95 $8.95
$10.01-$20.00 $7.95 $10.95
$20.01-$40.00 $11.95 $15.95
$40.01-$60.00 $14.95 $19.95
$60.01-$80.00 $17.95 $22.95
over $80.00 add 13% of total add 13% of total

Make checks payable to:  Rick Moore

We are currently only taking checks / money orders/ or PayPal (a secure site for credit cards)

Name on Card:______PayPal________________________ Card Number: ____PayPal_______________________
 

Signature:________PayPal__________________________

  

Exp. Date: month_________  year: _________
Message :________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Mail this order form with your check or money order to:
Rick Moore
10449 Orange Blossom Ln.
Seminole, FL 33772
Any questions or comments?    EMAIL

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