Purchaser_____________________________________________________

Address_______________________________________________________

City________________________________State_________Zip__________

Ship to_______________________________________________________

Address_______________________________________________________

City________________________________State_________Zip__________

 
Please print out, fill in all information, and mail form with check or money order.

Item# Description Price @ Quantity $ Amount
         
         
         
         
         

 

Subtotal____________

Shipping & Handling (add 20%)____________

Total____________

 

Signature______________________________________

Date__________________________________________

Mail form with check or money order payable to Zoharo to:

Zoharo
2135 Dresden Road
Zanesville, Ohio
USA     43701 - 2103

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