Order Form
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Name: |
______________________________ |
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Address: |
______________________________ |
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______________________________ |
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City: |
______________________________ |
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State: |
______________________________ |
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Zip: |
______________________________ |
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Phone: |
______________________________ |
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Quantity |
Description |
Color |
Price Each |
Total Price |
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Subtotal: |
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Sales Tax (OK add 8.0% tax): |
____________________ |
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Shipping & Handling: Total: |
____________________ ____________________ |
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Payment (choose one): __ Check/Money Order (Enclosed) __Credit Card
Credit Card Information
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Name on Credit Card: |
______________________________ |
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Card Number: |
______________________________ |
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Expiration Date: |
______________________________ |
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CVV Number: |
______________________________ |
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(3 digit
number on the back of your credit card; located on the signature strip) |
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Mail To:
Adaptations, Inc.
5 "F" Street SW