177 Sandpiper Road * Cochran, GA 31014 Email: iris@abtn.com * Phone: (478) 397-7416 |
|
Name:_______________________________________________________________________________ Address:____________________________________________________________________________ City/State/Zip:_______________________________________________________________________ Phone:______________________________________________________________________________ Fax:________________________________________________________________________________ E-Mail::_____________________________________________________________________________ |
|
Ship to (if different than above) Name:_______________________________________________________________________________ Address:____________________________________________________________________________ City/State/Zip:_______________________________________________________________________ |
|
Item Name____________________________________________________________________________ Item #___________________ Cost Each: $______________ Quantity: _______ Total: $____________ Item Name____________________________________________________________________________ Item #___________________ Cost Each: $______________ Quantity: _______ Total: $____________ Item Name____________________________________________________________________________ Item #___________________ Cost Each: $______________ Quantity: _______ Total: $____________ Item Name____________________________________________________________________________ Item #___________________ Cost Each: $______________ Quantity: _______ Total: $____________ .............................................................................................................TOTAL: $__________________ When you have your total above, mail your payment by check, money order, or credit card to the address above. Add 15% S&H to have your order shipped to your address above. ALL INFO AS IT APPEARS WITH YOUR CREDIT CARD COMPANY: NAME:_____________________________________________________________________________ ADDRESS:__________________________________________________________________________ CITY/STATE/ZIP:___________________________________________________________________ PHONE:____________________________________________________________________________ E-MAIL:___________________________________________________________________________ CREDIT CARD NUMBER:_______________________________________________________________ EXPIRATION DATE:__________________________________________________________________ LAST 3 DIGIT CODE ON BACK OF CARD:________________________________________________ YOUR SIGNATURE IS REQUIRED:_______________________________________________________ |
|
Iris Brand Enterprises |