Printable Mirror Order Form

BusterSoft ™ GALLERY (1-800-598-7238) PRINTABLE MIRROR ORDER FORM

ITEM	QTY.	Size In.	Price	Item Total
Large Horse Collar Wall Mirror	.	16"x27"	275.00	.
Check Here To Place Reservation If Out-Of-Stock
			Subtotal	.
Standard USPS Insured Shipping			Shipping	FREE
Optional Fedex ShippingNextDay2ndDay3rdDay			Opt.S&H	(will notify)
Alabama residents add 4% Sales Tax			Tax	.
Make check or MO payable to BusterSoft Gallery and mail to: P.O. Box 131, Verbena, AL 36091			Total	.

ORDERS PAID BY CHECK SHIPPED WHEN CHECK CLEARS
Order Toll Free: 1-800-598-7238 (Hours 8a-12p est)
or FAX credit card orders to 1-205-755-5586
or mail to: P.O. Box 131, Verbena, AL 36091

Name:________________________________________ Date of order:_________

Company (if applies)__________________________________________________

Street Address:______________________________________________________

___________________________________________________________________

City:_______________________________ State/Province: _________________

ZIP/Postal Code:___________________ Country:__________________________

Phone: _________________________ Evenings: _________________________

Payment By: Amex MasterCard Visa Check Money Order

Card Number: ______________________________________________________

Card Epiration Date: (MM/YY) _________________________

Signature: _____________________________________________________

Billing Name & Addr (If Different):________________________________________

___________________________________________________________________

Comments/Special Instructions: _______________________________________
___________________________________________________________________
___________________________________________________________________ (attach additional pages if needed)

Notice: We Do Not Compile Mailing Lists Or Share Customer Information!

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