BUSINESS NAME (if app.)__________________________________
EMAIL ADDRESS: _______________________________________

VISA____ MASTERCARD____ AMERICAN EXPRESS____
CARD NUMBER: __ __ __ __/ __ __ __ __/ __ __ __ __/ __ __ __ __
CARD EXPIRATION DATE: ____/____
CHECK____ MONEY ORDER____
SIGNATURE IS REQUIRED:
X _________________________________________________

PLEASE FILL IN NUMBER OF EACH ORDERED:
Gift Basket Merchandise Wholesale Sources Directory $20.00_____
Drop Shippers Wholesale Sources Directory $20.00_____
Dollar Store Merchandise Wholesale Sources Directory $20.00____
Nautical Gifts Wholesale Sources Directory $20.00_____
Lawn & Garden Products Wholesale Sources Directory $20.00_____
Canadian Wholesale Sources Directory $20.00_____
Arts & Crafts Wholesale Sources Directory $20.00_____
Artificial Flowers Wholesale Sources Directory $20.00_____
Candle & Soap Making Wholesale Sources Directory $20.00_____
General Wholesale Sources Directory $20.00_____
Shipping charge is $3.00
Shipping to Canada is $5.00 (USA Funds)
TOTAL PAYMENT ENCLOSED $___________

SHIP TO NAME AND ADDRESS (If different than charge to):
_____________________________________________________

MAIL TO:
Mitchell Wholesale
P.O. Box 208
Valley Falls, New York 12185

Email: info@versatile-contents.com