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Order Form

Name: _____________________________________________
Address: _________________________________________________
City: ________________ State: ___ Zip: _________-______
Products:
______________________ # of Items __ Price ______
______________________ # of Items __ Price ______
______________________ # of Items __ Price ______
______________________ # of Items __ Price ______

Payment Method:
Cash __ Cheque __ Food Stamps __

Credit Card
Visa __ Master Card__ American Express__
Discover __ ATM __ Target Card __

Political Party:
Republican __ Democratic __ Whig __ Communist __
Reformist __ Green __ Confederate __ Christian __

Favorite Historical Figure:
Hitler __ Jesus __ Josh and Elliott __ Genghis Khan __

Any Suggestions?
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