BusterSoft GALLERY (1-800-598-7238) PRINTABLE MIRROR ORDER FORM
This Is:My Only Order Today Part Of A Multi-Part Order
ITEM
QTY.
Size In.
Price
Item Total
Large Horse Collar Wall Mirror .
16"x27"
275.00
 .
Check Here To Place Reservation If Out-Of-Stock
Subtotal
  .
Standard USPS  Insured Shipping Shipping
FREE
Optional Fedex ShippingNextDay2ndDay3rdDay
Opt.S&H
(will notify)
Alabama residents add 4% Sales Tax
Tax
  .
Make check or MO payable to BusterSoft Gallery
and mail to:  P.O. Box 131, Verbena, AL 36091
Total
  .
ORDERS PAID BY CHECK SHIPPED WHEN CHECK CLEARS
Order Toll Free: 1-800-598-7238 (Hours 8a-12p est)
or FAX credit card orders to 1-205-755-5586
or mail to: P.O. Box 131, Verbena, AL 36091
Name:________________________________________  Date of order:_________
Company (if applies)__________________________________________________
Street Address:______________________________________________________
 ___________________________________________________________________
City:_______________________________   State/Province: _________________
ZIP/Postal Code:___________________ Country:__________________________
Phone: _________________________  Evenings: _________________________
Payment By: Amex MasterCard Visa Check Money Order
Card Number: ______________________________________________________
Card Epiration Date: (MM/YY)   _________________________
Signature: _____________________________________________________
Billing Name & Addr (If Different):________________________________________
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Comments/Special Instructions: _______________________________________
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(attach additional pages if needed)
Notice: We Do Not Compile Mailing Lists Or Share Customer Information!

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