|
| |
Item |
Quantity |
Price
ea. |
Cost |
| Brush
Butler, Green & Brown Spec |
|
$29.95
ea. |
|
| Brush
Butler, Denim Blue |
|
$29.95
ea |
|
| Brush
Butler, Vanilla Bean |
|
$29.95
ea |
|
|
Subtotal:
|
|
6.5%
sales tax (Florida residents only): |
|
$10.00
Shipping Now - Free Shipping! :
|
|
|
|
|
| Total: |
|
| |
|
| Payment
Method |
| |
 Check
#__________________ Money
order / cashier's check |
| Credit
Card |
| |
Visa
Mastercard (circle)
|
| |
Card #___________________________________________ Expiration
Date: ___________ |
| |
Name
on card: ________________________________________________________________ |
| |
Billing
Address: ________________________________________________
Apt: __________ |
| |
City:
_____________________________________________________ Zip:
______________ |
Shipping
Information |
| |
|
|
Ship
to same name and address as on credit card |
|
Ship to:
|
| |
Name:
_______________________________________________________________________ |
| |
Street
Address: __________________________________________________ Apt:_________ |
| |
City:
________________________________________________________ Zip:
____________ |
| |
|
| To
submit your order, choose one of the following options: |
| |
• Fax
this form to: (561) 848-3987, or |
| |
• Call
in your order by phone at (561) 848-3987, or |
| |
•
Mail this form to: D&H Studio, 1065 Silver Beach
Road, #14, Riviera Beach, FL, 33403 |
|
Thank
you for your business! |
|
|
|
