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ORDER FORM

 

Ship to:____________________________ Check payment method:                                                                                         Address:____________________________ CreditCard___Check___Money Order____                                                                                                  ____________________________   Charge my: VISA____MasterCard____    City:_______________________________   If paying with your credit card, fill in   State Province:______ Zip Code _____   Credit Card Info below:    Country:____________________________   Card # :_______________________________    E-Mail:_____________________________   Expiration Date:_______________________    Telephone:(optional)________________   Signature:_____________________________    ________________________________________________________________________________ |Item Number |            Title             | Quantity   |   Price    |   Total  | |____________|______________________________|____________|____________|__________|                                                                                                                                               |____________|______________________________|____________|____________|__________|                                                                            |____________|______________________________|____________|____________|__________|                                                                                                         |____________|______________________________|____________|____________|__________|                                                                                                                                    Subtotal|__________|                                                                        Subtotal |__________|                                                                          US: $3.95 Standard Mail, $4.95 Priority Mail |__________|                               Canada: $5.95; Rest of the World: $6.95 |__________|                                                                                                                                 Total Amount Enclosed |__________|                                                                                                               Please use additional sheet of paper if necessary to complete your order.              Mail this order form with payment to:                        C.B. Green                       P.O. Box 22323                       Tampa, Florida 33622                       U.S.A.           RETURNS... If for any reason you are not completely satisfied just return merchandise(Grocery Coupon)within 30 days, in saleable conditions, for prompt refund. No questions asked. Enjoy!