ADDRESS______________________________________________
CITY_________________________STATE_____________ZIP________
EMAIL ADDRESS_____________________________________________
.
VISA____MASTERCARD____AMERICAN EXPRESS____
CARDHOLDERS NAME (IF DIFFERENT)_______________________________
CARD # __ __ __ __/ __ __ __ __/ __ __ __ __/ __ __ __ __
EXPIRATION DATE ___/___
CHECK ___ MONEY ORDER___
NUMBER OF DIRECTORIES ORDERED ____
INCLUDE $20.00 PER DIRECTORY
ADD $3.00 SHIPPING & HANDLING CHARGE PER DIRECTORY
TOTAL OF ORDER $__________
SHIP TO ADDRESS (IF DIFFERENT THAN ABOVE)
______________________________________________________
______________________________________________________
MAIL TO:
Mitchell Wholesale
P.O. Box 208
Valley Falls, New York 12185
Email address info@versatile-contents.com
