| Name:
___________________________________________ |
| Email:
___________________________________________ |
| Address:
_________________________________________ |
| City:
____________________________________________ |
| State: ____________________ |
| Country: _________________ |
| Zip: ____________________ |
| Phone: (___) ____- ______ |
| |
| Item No.
____________________________________________ |
| |
| Total all items above: ______________ |
| Add Sales tax 6.5%: ______________Minnesota
Residents only.
|
| Total Amount: $___________________ |
I am enclosing a check or money order for
$_________USD.
Please note that we do not accept checks by fax, Please make
checks or
money orders payable to: Mikes Gifts and More, and mail it to
the address above.
__________________________________________________________________________________________
|
| I authorize Mikes Gifts and More; to charge
$_________USD to my credit card for items purchased. (check
one): |
| VISA____ MasterCard____ American Express____
Discover____ Card Number: _________________________
Valid Thru Date: _______ Signature:
_____________________________ |
|
