Name:______________________________________ Address: __________________________________ City: _____________ State/Province:________ Zip:__________ Country: ________ Phone: ______-______-_________ E-mail:__________________________________
ITEM # Description QUANTITY PRICE
#_____ _________________________ ________ $________
#_____ _________________________ ________ $ _______
#_____ _________________________ ________ $________
#_____ _________________________ ________ $________
#_____ _________________________ ________ $ ________
#_____ _________________________ ________ $ ________
Subtotal _____________
Tax _____________ (6% CT residents)
Shipping _____________
Total Amount due _____________
(If sending check please email order for shipping charges)
(we need your zipcode for 'distance' and total items for 'weight')
Send Check, Money Order, Visa, MasterCard or Discover Order to:
Streamers Country Ceramics
1 Hazelwood Dr.
Baltic, CT 06330
Information
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