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| Order Form |
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Shipping Information:| Name: | | Address: | | Address: | | City: | State: | Zip: |
Item
#1| Item
Number: | Quantity: | | Item
Description: | | Size: | Color: | | Price
per item: | Total
Price: |
Item
#2| Item
Number: | Quantity: | | Item
Description: | | Size: | Color: | | Price
per item: | Total
Price: |
Item
#3| Item
Number: | Quantity: | | Item
Description: | | Size: | Color: | | Price
per item: | Total
Price: |
| Subtotal: | | | Add
8.25% sales
tax: | | | Add
shipping charges (add $4 for first item and $1 for each additional
item): | | | Total
Amount: | |
Print
out this order form and mail it along with your check payable to
'Premier Specialty Products' at:
Ricky Cueva, SHPE
Mercado Representative
Premier Specialty
Products
24876 Apple Street, Suite A
Santa Clarita,
CA 91321
Phone:
888-369-2200 |
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