Print Form, Fill in the quantity by the item(s) you want and mail form with payment.
 
Pay to & Mail To:
 DeWayne Harlow
33935 N. Corbin
Walker, La.    70785
Qty
Item #
Item Description
Price
Each
Total
       
       
       
       
 
 
 
 
 
 
   
Sub Total 
    
   
*Shipping (see below) 
    
   
Total 
    
*Shipping - $0.01 to $100.00 = $4.00,     $100.01 to $200.00 = $5.00,
$200.01 to $500.00 = $6.00,     $500.01 and up = $8.00
Sorry, we can't accept International Orders by check.

Ship To:

Name _____________________________________________________Date ____/____/____

Address _______________________________________________________

City __________________________ State _______________ Zip ________

Country ______________________________________________________

Email ________________________________________________________