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Printable Blank Address Forms

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Printable Blank Address Forms Powered By Docstoc
					                                                           Mail Order Form
WHOLESALE GOODS, LLC
1761 George Washington Way, Ste 190
Richland, WA 99354 (USA)                                                                               Date:
509‐967‐3867 (Office) | 509‐396‐2396 (Fax)


Ship To:      Name:
              E‐mail:
              Address:
              City, State, Zip:
              Phone:
              Payment:  |  |  Check  |  |  Money Order  |  | Visa  |  | MC  |  | Discover  |  |  American Express
              Name on Card:                                                      Card #:
              Expiration Date:                                                   CVS #:
              Customer Signature: 


    Qty          Item #     Description                                                                         Price                   Total




 By placing this order I certify that I am over the age of 18 or that I have parental                                Subtotal
 consent to purchase these items.  I further state that I agreee to and understand the 
                                                                                                      Shipping (see below)
 Terms & Conditions stated on our website (wholesalegoods.net).  I also understand 
 that it is my responsibility to check all local laws regarding legality of this product          Sales Tax (8.3%) WA only
 in my area.  By placing this order I further state that none of these products will be 
 shared with anyone under the age of 18 without adult supervision or consent.                                           Total

 Made check or money order payable to Wholesale Goods, LLC.



                                                                                  Authorized by                                 Date

              Shipping: $1.00‐$14.75=$6.00 | $14.76‐$29.95=$7.97 | $29.96‐$49.75=$9.97 | $49.76‐$99.95=$12.97 | $99.96‐$199.75=$14.97

				
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Description: Printable Blank Address Forms document sample