ADDRESS______________________________________________
CITY______________________PROVINCE_____________POSTAL CODE__________
EMAIL ADDRESS_____________________________________________
.
VISA____MASTERCARD____AMERICAN EXPRESS____
CARDHOLDERS NAME (IF DIFFERENT)_______________________________
CARD # __ __ __ __/ __ __ __ __/ __ __ __ __/ __ __ __ __
EXPIRATION DATE ___/___
CHECK ___ MONEY ORDER___
NUMBER OF DIRECTORIES ORDERED ____
INCLUDE $20.00 (U.S FUNDS) FOR EACH DIRECTORY ORDERED
ADD $5.00 SHIPPING & HANDLING
TOTAL OF ORDER $__________ (U.S. Funds)
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
