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14000 W. 215th St., Bucyrus, KS 66013-9519 Ph. 913-879-2587 - 7:30 A. M. - 3 P. M CST Monday-Friday 24-hour Fax. 913-533-2497 Minimum order $10.00 |
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Name ___________________________________________________ Date _____________
Address___________________________________________ (UPS requires a physical address)
City, State, & Zip Code________________________________________________________
Ph. #____________________ E-mail ___________________________________________
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Shipping Charges (call or e-mail us) |
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Sales Tax (Kansas residents only) |
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Method of Payment
_________Check or Money order Discover, Master Card, Visa (Circle Card Company)
Card #__________________________________________ Exp. Date: __________________
Card billing address ___________________________________________________________
__________________________________________________________________________ (signature of Credit Card Holder)
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