| Ordered by: Name________________________________ Address______________________________ City_________________St.____Zip________ Phone____________________Date________ | Shipped to: Name________________________________ Address______________________________ City_________________St.____Zip________ _____________________________________ |
Item No. | Qty. | Description | Price |
Total Price |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| _________ | _____ | _______________________________ | ______________ | ___________ |
| Subtotal | ___________ | |||
| Shipping | ___________ | |||
| Sales Tax (6% WV Only) | ___________ | |||
| Grand Total | ___________ |
Thank you and God bless you and your family!