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LAPPS BEES SUPPLY CENTER 500 S. MAIN ST., P.O. BOX 278, REESVILLE, WI. 53579 PHONE/FAX (920) 927– 3848 ~ ~ ~ 1-800-321-1960 Email: lappsbeesupply@yahoo.com |
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DATE________________ , 20___ NAME______________________________________________________________ ADDRESS___________________________________________________________ CITY_________________________STATE___________ZIP CODE___________ PHONE ( )_____________________ COUNTY_________________________
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NOTE: IF WE ARE TEMPORARILY OUT OF ANY ITEMS ON ORDER, PLEASE CHECK IF YOU WANT CANCELED OR BACK ORDER. |
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Canceled |
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Back Order |
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NEED MORE BLANKS?
____YES ______NO |
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TO PRINT OUT THIS PAGE, RIGHT CLICK AND CLICK PRINT. THEN YOU CAN PRINT THE FORM AND USE IT. YOU CAN CUT THIS PART OFF. |
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PAYMENT METHOD AMOUNT ENCLOSED__________________
DISCOVER MASTERCARD VISA
CHECK MONEY ORDER
CARD ACCOUNT NUMBER:
CARD EXPIRATION DATE: CVV ______________________________________ CUSTOMER SIGNATURE |
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PAYABLE IN US DOLLARS ONLY. THANK YOU FOR YOUR ORDER. |
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CATALOG NO. |
QTY |
DISCRIPTION |
UNIT PRICE |
TOTAL PRICE |
SHIP WT. LBS OZ. |
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Total for Order |
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Shipping Charges |
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WI Residents Only |
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Add 5-1/2% Sales Tax |
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Amt. Due from Previous Order |
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Total Amount ( add carefully) |
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CHECK, MONEY ORDER |
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REFUND VOUCHER |
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Total Wt. |
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Lb. |
Oz. |
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Total Wt In lbs. |
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16 oz. = 1 lb. Count any remaining oz. As a full lb. |
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