| DATE: | FAX (303) 479-9102 |
| NAME | |
| ADDRESS | |
| CITY/STATE/ZIP | |
| PHONE | EMAIL ADRESS |
| QUANTITY | ITEM # | DESCRIPTION | PRICE | AMOUNT |
| $ | $ | |||
| $ | $ | |||
| $ | $ | |||
| $ | $ | |||
| $ | $ | |||
| $ | $ |
|
TOTAL
|
$ |
|
*SHIPPING
|
$ |
|
TOTAL
|
$ |
| VISA/MASTERCARD | EXPIRATION DATE |
| SENDING CHECK(MAKE PAYABLE TO CHICKEN CREEK) |
Would you like a gift card included? (send second page with message and alternative shipping address)
*Based on the amount of your order, please add the following charges for shipping/handling in the continental U.S. Please call for shipping charges to other areas. If shipping to more than one address, separate shipping charges will apply.
| $00-$49=10.50 | $ 50-$ 99 =$ 11.50 | $100-$149 =$ 13.00 | $150-$199 =$14.50 | $200+ =$16.00 |
FAX TO: (303) 479-9102