John and Eileen Zanderzuk
736 East Canal Road
Dover, PA 17315
| | |
John and Eileen Zanderzuk 736 East Canal Road Dover, PA 17315
|
Name ______________________________________________ Date __________________ Address ___________________________________________ Phone _________________ City ____________________________ State ____________Zip ___________________ E-mail ___________________________________Alternate Phone__________________
Quantity Description Size Price Total
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
MINIMUM ORDER $25.00
Subtotal ______________
SHIPPING CHARGES
PA orders - Add 15% PA Res. Add 6.00% tax ______________
Out of State - Add 20% Handling and Packing $4.00
(Any additional shipping costs will Shipping _____________
be forwarded to you with a receipt -
or excess costs will be refunded to you) Total _____________
PLEASE LIST SUBSTITUTES
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________