Mail Order Form
HCR 69 BOX 61  • OLDFIELD, MO 65720
(417) 683-6295

U.S. POSTAL MAIL ORDER FORM

Please print out this form and send with payment in the form of credit card
information: (MC/Visa/AmEx accepted). We also accept personal checks
and money orders drawn from a US Bank.
       
Name _________________________________ Phone _______________________
Address _________________________________ Email _______________________
City/State _________________________________    
Country _________________________________ Zip Code ________ - ______
       
  CREDIT CARD INFORMATION    
Check One _____ MC _____ Visa _____ Amex    
Cardholder _________________________________    
Account # _________________________________ Expires ________/________
Signature _________________________________    
 
STOCK # DESCRIPTION QTY PRICE TOTAL
_______ _____________________________________________ _____ _____ _________
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  Thank you for your patronage      
    GRAND TOTAL $ ________