Buckles Etc Order Form
Printable order form for Mailing
Back to ordering instructions
| Buckles Etc. Order Form |
Shipping Address if Different From Billing Address Below |
| 732 Tracy Circle |
Name |
| Unadilla Ne. 68454-4261 |
Address |
| Phone 402-828-2222 |
State and Zip Code |
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Phone |
| Email jf@bucklesetc.com |
Email |
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Description |
Quantity |
Price |
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| Master Card Visa Discover American Express |
Total Product |
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| Account Number |
Sales Tax 7% |
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| Expiration Date Security Code |
Priority Mail $15.00 |
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| Billing Address |
Second Day Air $30.00 |
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| State and Zip code |
Insurance $2.00 Per $100.00 |
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| Signature |
Total Due |
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Questions? Give us a call,402-828-2222, Thank you Jerry and Kathy