PRODUCT ORDER FORM

Copy and fax to 1-405-759-2074

Or mail to: Steve Johns, PO Box 7002 Moore, OK 73153

 

NAME                                                                                                                                                                   

COMPANY                                                                                                                                                            

ADDRESS                                                                                                                                                             

CITY                                                                                   STATE                                         ZIP                           

PHONE                                                                                           FAX                                                                

E-MAIL                                                                                                                                                                    

 

PRODUCT 1.                                                                                                         $                             

PRODUCT 2.                                                                                                         $                             

PRODUCT 3.                                                                                                         $                             

PRODUCT 4.                                                                                                         $                             

                                                                                                    ADD SHIPPING $                             

                                                                                                                 TOTAL $                             

 

PAYMENT CHOICE:                  VISA                  MC                  AMEX                  DISC ________ CHECK

CC NUMBER                                                                                                         

EXP. DATE                                        

NAME AS IT APPEARS ON CARD                                                                                                                         

SIGNATURE                                                                                                                        (required)

 Note: You must use the mailing address where your credit card statement is sent