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Blank Order form (Simply print this page, fill out your copy, and send it in) |
| Name: | _________________________________________________________ |
| Address: | _________________________________________________________ |
| City: | _________________________________________________________ |
| State: | _________________________________________________________ |
| Zip Code: | _________________________________________________________ |
| Day Phone: | _________________________________________________________ |
| E-Mail: | _________________________________________________________ |
| Item #: | Description: (w/size) | Quantity: | $ Each: | $ Total: |
| ______ | ____________________________ | ________ | _______ | _______ |
| ______ | ____________________________ | ________ | _______ | _______ |
| ______ | ____________________________ | ________ | _______ | _______ |
| ______ | ____________________________ | ________ | _______ | _______ |
| ______ | ____________________________ | ________ | _______ | _______ |
| ______ | ____________________________ | ________ | _______ | _______ |
| Sizes & Prices: | Total:_____________________ |
| Image on 8½x11 paper: $25 | In Michigan 6%:____________ |
| Image on 13x19 paper: $40 | Order Total:_______________ |
| Check (___) Please make payable to Jeff Holbrook |
| Money Order (___) Please make payable to Jeff Holbrook |
| Signature____________________________________________________ |
| Send to: Jeff Holbrook, 4098 Moulton Dr., Flint, Michigan 48507 Thank You! |
| www.jeffholbrook.com |
| (810) 513-1369 |