Please print this form, fill it out, and mail.


Tracy Gallup
Please print and send this page with your payment to:
Tracy Gallup
534 Glendale Circle
Ann Arbor, MI 48103
Phone (734)997-9023


ORDER FORM

  

SHIP TO:

BILL TO:

Name:        _______________________

Name:       _______________________

Co. Name: _______________________

Co. Name: _______________________

Address:    _______________________

Address:    _______________________
Address:    _______________________ Address:    _______________________

City:___________________ State:___________

City:___________________  State:__________
Zip:_____________ Country:_______________ Zip:__________   Country:_________________


Please send the following items

Qty. Item Size/Type Color Price TOTAL
. . . . $ $
. . . . $ $
. . . . $ $
. . . . $ $
. . . . $ $
. . . . $ $
. . . . $ $
. . . . $ $
. . . . $ $
E-Mail Tracy
with questions
. . $ $
. . $ $

Shipping Charge to
be calculated.

SUBTOTAL $
Shipping $

   ( Michigan residents add 6% sales Tax )

MI Add 6%    Tax $
   Make check payable to Tracy Gallup TOTAL DUE $

Catalog included with each paid order.
Catalog alone is $5.00, refundable with order, but website is more complete.
Please call or E-Mail with any questions.
Thank You.


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