Sponsored by

Print and mail this order form to our shop address below or Fax it to 1-765-457-1500
or call 1-765-457-1500 from 9AM to 5PM Monday thru Friday Central Time.

WE SHIP WITHIN 24 HOURS!

ORDERED BY
NAME-----------------------------------------------------------------------------------------------------------------
STREET--------------------------------------------------------------------------------------------------------------
CITY-------------------------------------------------------------------------------------------------------------------
STATE----------------------------------------------------COUNTRY----------------------------------------------
ZIP CODE-------------------------------------------------------------------------------------------------------------
DAYTIME PHONE#-----------------------------------------------------------------------------------------------
E MAIL----------------------------------------------------------------------------------------------------------------

QTY	ITEM#	DESCRIPTION	$EACH	AMOUNT
.	.	.	.	.
.	.	.	.	.
.	.	.	.	.
.	.	.	.	.
.	.	.	.	.
.	.	.	SUB-TOTAL	.
.	.	.	P&H	.
.	.	.	TOTAL	.

POSTAGE&HANDLING

ADD TO ORDERS Order Amt. P&H Fee $00.00-$29.99......$8.00 $30.00-$49.95......$10.80 $50.00-$79.95......$12.75 $80.00-$99.99......$15.50 $100.00-.................FREE PAYMENT METHOD Order Must Be Payed With US Funds Only. Shipping to U.S. only. Check Or Money Order Payable to: WIESE ENTERPRISES 1622 SOUTH UNION ST. KOKOMO,INDIANA 46902