Please PRINT and MAIL completed form to:
Dusty Lanes
Rt. 2 Box 8
Bison, OK 73720
Billing Information
Shipping Information
Name:___________________________________
Address:_________________________________
City:_____________________________________
State:______________Zip:___________________
Telephone:________________________________
Email:__________________________________
Name:___________________________________
Address:_________________________________
City:_____________________________________
State:______________Zip:___________________
Telephone:________________________________
Email:___________________________________
Qty
Item #
Description
Frame
Price
Total
1
2
3
3
5
6
7
8
9
10
Subtotal:
Please note frame style desired for each picture above in the “frame” column.
(#BWF1100 for Barnwood),(#CWF1200 for Cedar) or (none for No Frame)
Frames: $5.00 each x _____
Subtotal with Frames:
Shipping $7.50 for Order totals $0—$60.00
free shipping for Order totals $60.00 or over
Shipping:
(in Oklahoma please include 8.35% tax)
Tax:
TOTAL AMOUNT DUE:
Sorry no C.O.D.’s or cash.
Please send check or money order for the total made payable to: B. Roberts.
There is a $25.00 service charge on returned checks.
A confirmation letter will be sent by e-mail upon receipt of your order and full payment.
If you have any questions please email dustylanes@excite.com.
