Order Form
Today's Date:______________
Purchaser:
Name:_______________________________
Address:__________________________________
City: __________________ State: ___ Zip: ______
Telephone: ____ ____ _______
Email:_______________________________
All orders are shipped Priority Mail within 7 business days.
Credit Card orders may also be faxed to
434-
Ship to:
Name:________________________________
Address:___________________________________
City: ____________________ State: ___ Zip: ______
Email:_______________________________
Qty
#
Description
Price Per
Total
Sub Total
Virginia residents: 4.5% sales tax
Priority Mail, Shipping & Handling
$ 5.00
Total
PAYMENT METHOD
{ } Check { } Visa { } Master Card
{ } Discover { }Amex
Card Number: __________________________________
Expiration Date: Mo. _____ / Yr. _____
________________________________
Signature
Mail orders to:
Just Liz
PO Box 11
Monroe, Virginia 24574
434.384.1828