1. SOLD TO:
Name:____________________________________
Street Address:_____________________________
City/State/Zip Code:_________________________
_________________________________________
Phone: ___________________________________
Currahee PX Order
FAX: 1-406-293-7678
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1. SOLD TO: Street Address:_____________________________ City/State/Zip Code:_________________________ _________________________________________ Phone: ___________________________________ |
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QTY. |
COLOR/SIZE |
DESCRIPTION |
NIT PRICE |
TOTAL PRICE
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TOTAL AMOUNT |
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FOR DOG TAG ORDER
| LAST NAME | |
| FIRST & MI | |
| SERVICE # | |
| BLOOD TYPE | |
| RELIGION |
2. METHOD OF PAYMENT Visa:____ Master Card:____
Card #: ________________________________________________ Exp. Date: ___/___
Signature: _______________________________________________________________
Shipping Instructions: FedEx ___ Priority Mail ___ UPS ___ Regular or Media _____
*Check here _____ if you wish to know shipping cost prior to processing your order.