Basket Class
2012 Southlawn Drive, Des Moines, IA 50315-4981
(515)285-2789 Fax: (515)256-1482
Email: basketclas@aol.com
Web Site: http://basketclass.com
Order Form
| Billing Address | ||
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First and
Last Name _________________________________
Street Address _________________________________
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City
__________________________ State _______________ Zip
____________ Country
_______________________
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Email Address ______________________________________
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| Shipping Address (If different than above) | ||
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First and
Last Name _________________________________
Street Address _________________________________
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City
__________________________ State _______________ Zip
____________ Country
_______________________
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Email Address ______________________________________
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| Quantity |
Item |
Details
- Size, Color, etc. |
Price
of Each |
Price |
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__________________________________
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$__________
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$__________
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$__________ |
$__________ |
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$__________ |
$__________ |
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$__________
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$__________
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__________________________________ |
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$__________
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$__________
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__________________________________
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$__________ |
$__________ |
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$__________
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$__________
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$__________
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$__________
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$__________ |
$__________ |
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$__________
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$__________
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__________________________________
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_______________ |
$__________ |
$__________ |
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__________________________________
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_______________
|
$__________
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$__________
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| ____ |
__________________________________
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_______________
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$__________
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$__________
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| Credit Card Information Name on Credit Card _______________________________ Type of Credit Card Visa _____ Master Card _____ Discover _____ Credit Card Number ________________________________ 3 digit # on back of Credit Card_______Expiration Date ________ |
Sub Total |
$__________
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| Iowa
Tax 6% |
$__________
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Shipping Charge |
$__________ | |||
| Total |
$__________
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Instructions/Comments
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