21952 County Hwy. SR   Richland Center, WI   53581

(608)475-0531   Home (608)647-5007


Order Form

                        ITEM          QTY.          DESCRIPTION                                                                 PRICE EACH      TOTAL

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                                     Wisconsin residents must add 5 1/2%  SALES TAX  

                       Please print and mail this order form or call in your order.  Payment can be made by check, money order or

                        credit card.  Personal checks must clear before items are shipped.


                                       Credit card payment:       Mastercard                Visa             Discover          

                                       Card number                                                                          Exp. date                            

                                       Signature ________________________________________________________________