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MAIL ORDER FORM |
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Print this page (1) and mail
to:
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LVBC
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PO BOX 101326
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Denver, Colorado 80205
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Date__________________
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ITEM:_______________________________________ |
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Item number:___________________
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Description of
item:______________________________________________________
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__________________________________________________________ |
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AMOUNT:
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Price:
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$_______________ |
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Tax, if applicable:
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$_______________ |
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Total purchase:
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$_______________ |
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| METHOD OF PAYMENT:
Check____Money Order____C.O.D____
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BUYER'S NAME AND ADDRESS: |
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Name:_________________________________________________________________ |
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Address:_______________________________________________________________ |
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Address:_______________________________________________________________ |
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City:___________________________State______________________Zip_________ |
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Country:________________________ |
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Phone:_________________________
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E-mail:_________________________ |
| SHIP TO: |
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Name:__________________________________________________________________ |
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Address:________________________________________________________________ |
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Address:________________________________________________________________ |
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City:___________________________State______________________Zip__________ |
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Country:________________________ |
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May we confirm this order by:
Phone yes___no___ U.S. Mail
yes___no___ E-Mail yes___no___ |
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SPECIAL INSTRUCTIONS: |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________ |
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_______________________________________________________________________
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