| To order, print a copy of this form, fill it out and mail it to us or call or fax us at 406-827-7625. NOTE: Please include your e-mail address so we can contact you about your order if necessary. Thanks. |
| Name: | PO#: | Date: | |||
| Address: | City: | State: | Zip: | ||
| Phone: ( ) | e-mail: | ||||
| Item # | Description | Price ea. | Quatity | Amount |
| SUBTOTAL | $_________ | |||
| SHIPPING & HANDLING |
| If your subtotal is $17.00 or less, Add $5.00 | $_________ | ||||
| If your subtotal is $17.01 to $49.99, Add 30% | $_________ | ||||
| If your subtotal is $50.00 to $99.99, Add 20% | $_________ | ||||
| If your subtotal is $100.00 or more, Add 15% | $_________ | ||||
| TOTAL | $_________ | |||
| My Check/Money Order is Enclosed ___ | ||||||
| Charge My: MC __ VISA __ | Card #: _______ - ________ - ________ - ________ | |||||
| Exp Date: _____________ | ||||||
| Authorized Signature: ____________________________________________ | ||||||