order form for ferguson merchandise
ORDER INFORMATION BELOW: Please print, fill out and mail. See below.
NAME___________________________________PHONE (
)______________________
ADDRESS______________________________________________________________
CITY_______________________________________________________STATE______________ZIP______________________
Check
#_________________ Amount
$___________________
|
SHIPPING CHARGES --
U.S. CANADA Orders up to $20.00 ...........$4.95......$6.95 $20.01 to $40.00................$6.95......$8.95 $40.01 to $70.00................$8.95......$9.95 $70.01 to $100.00.............$9.95.....$10.95 $100.01 to $150.00........$10.95.....$11.95 $150.01 and over ...........$11.95.....$12.95 |
MasterCard/VISA
#__________________________________
Expiration Date_____________
Name on
Card_____________________________________
Signature__________________________________________
MAIL TO: ELLEN F. BOLTHOUSE, Mdse. Mgr., CFSNA, 210 Primrose Drive, Clarks Summit, PA 18411
PHONE:
(570)587-0232 E-mail:
ebolt@epix.net
ALL PROFITS FROM CLAN MERCHANDISE ACCRUE TO
THE CFSNA EDUCATIONAL TRUST
FUND.