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ORDER
FORM
(Please print and fax to
(703) 271-8886.
You may also send an email to SuproCo@aol.com)
| ITEM | PRICE/UNIT | QTY | TOTAL |
| Suzie Qs | $12.89 |
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| La Lift | $32.50 |
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| Tie Taches | $6.00 |
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| Dais-Zzzs | $6.00 |
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SHIPPING
& HANDLING (please refer to chart below) |
|||
GRAND
TOTAL |
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NAME:_________________________________________
SHIPPING ADDRESS:____________________________________________________________________________
DAYTIME TELEPHONE: ___________________________
E-MAIL: ________________________________________
PAYMENT:(Pls. circle one): Check enclosed/Money Order
SPECIAL INSTRUCTIONS: ______________________________________________________________________
SHIPPING/INSURANCE