MANUAL/FAX ORDER FORM

Use this form for sending fax orders or mailing orders by regular mail.

Name_______________________________________________________________

Address_____________________________________________________________

City_________________________ State_________________ZIP_______________

Home Phone _____________________ Work Phone_________________________

MANUAL/FAX ORDER FORM
ITEM NUMBER DESCRIPTION COLOR
(if applies)		 PRICE EACH HOW MANY TOTAL
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Type of Payment: [] Check [] Money Order

Signature _______________________________________

 COLUMN TOTAL �
TAX (AL only) �
SHIPPING �
RUSH SHIPPING �
SERVICE FEE �
GRAND TOTAL
(amount to be sent with order)		 �
INSTRUCTIONS:
For mail order print a copy of this order form, complete and mail check or money order to :
IMPORT AND EXPORT EMPORIUM
40 LAKEFRONT AVE.
PO BOX 4404
GADSDEN, AL 35904