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CLOCKWERX ORDER FORM
Fill out ALL AREAS below and click on the SUBMIT QUERY button to place your order.
You have TWO CHOICES of payment. You can pay VIA PAYPAL or SEND cashiers check or money order to the address below.
WE MUST RECEIVE PAYMENT BEFORE WE CAN START ON OR SHIP YOUR ORDER!
IF PAYING WITH PAYPAL or BIDPAY , USE westva1auctions@aol.com AS THE ADDRESS
YOU MAY ALSO SEND YOU ORDER VIA US MAIL TO:

Jerry E. Perdue
Route 1, Box 132
Petroleum, West Va. 26161




Name: Address: City,State,Zip:
Email: Form of Payment:
Total COST of clocks: Shipping Amount:
INSURANCE? Add $1.00 for $50 coverage or $2 for $100 coverage:

Quantity & Complete Description of ORDER:
INCLUDE COMPLETE DESCRIPTION, SHIPPING and INSURANCE CHARGES and MAKE SURE ALL AREAS ARE FILLED IN.


Date of your order is
NOTE: After clicking on "SUMBIT QUERY" button, press your browser "BACK" button to return to this page.
YOU MAY WANT TO "PRINT" THIS PAGE FOR YOUR RECORDS BEFORE CLICKING ON HOMEPAGE.
Quality CUSTOM DESIGNED CLOCK FACES from the HEART of West Virginia
Mystic Pines - Petroleum, West Virginia

Confirmation & Return