Streamers Country Ceramics
1 Hazelwood Dr. * Baltic, CT 06330
PHONE in Orders: "Toll free USA"- 1-888-345-1114
From outside the USA phone (860) 822-9151
CUSTOMER NAME:_____________________________________________________
ADDRESS:____________________________________________________________
CITY-STATE-ZIP:_______________________________________________________
PHONE: (________)_______________________ e-mail:_________________________________
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| SUB TOTAL |
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| Connecticut residents add 6% sales tax |
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| Needed if paying by check.(See order page) SHIPPING |
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| TOTAL AMOUNT |
$ |
Method of payment:
___ Check or Money Order - Payable to Streamers Country Ceramics (US funds only)
( Visa - Master - Discover ) Please Mark one!
___ Credit Card - Account #:_________________________________
Exp date:_______ CVS(Last-3 #'s on back):_______
AUTHORIZED SIGNATURE ______________________________________________
