Western Dreams Manual Order Form

FAX or MAIL ORDER FORM

1. Please Enter the Customer Billing Information (As it appears on your Credit Card):

Email Address:

Name:

Address:

Address line 2:

City:

State or Providence:

Zip or Postal Code:

Country:

Phone:

Fax:

2. Please Enter Ship To Address: (if different from above)

Use the same billing address as the shipping address.

Name:

Address:

Address line 2:

City:

State or Providence

Zip or Postal Code

Country:

Phone:

3. Please Fill in Your Order. (Prices listed in the Online Store)

Item#	Product Description	Price Ea	Qty	Total




		SubTotal
6% Sales Tax for Florida Residents Only		Sales Tax
	(See Order Info Page for shipping costs)	Shipping
		Total

4. Payment Method:

Mailing with Check

Visa

Master Card

Discover Card

Name on Card

Card Number

Exp. Date

Signature:

________________________________________

Message or Comments: (If you need more room, please put your comments on a separate page)

Thank You for Shopping with us!