Order Information
Simply fill out form below and chose one of the 2 options for submitting

1) Fax:   Print this form and fax it to (337) 266-5324
2) Mail:  Print this form and mail to Created By Mechel.128 Roger Rd, Lafayette, La 70507

Shipping Information
      Purchase      Shipping Cost

1.00 9.99 3.00 10.00 29.99 5.00 30.00 49.99 7.00 50.00 99.99 10.00 100.00 PLUS 15.00

   

Order Form

Product	Item	Description	Price	Qty.	Total
				Subtotal
				Tax
				Total

Shipping Address

Name
Address
City		State
Country		Zip
Email

Billing Address
  Check if same as shipping address

Name
Address
City		State
Country		Zip
Email

Billing Information

Credit card
Name on Card
Card number
Expiration & V-Code