Wild Rose Trading Co, PO Box 5174, Durango, CO 81301
Phone: (970) 259-8396	E-mail: sales@wrtcleather.com	FAX: (530) 504-9724

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CUSTOM LEATHER GOODS ORDER FORM

Please fill out, print, and mail or FAX in with your order. A 50% deposit is required at the time of order

Additional info will be asked for on the measurement & info form(s)

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Name Address Address City ST Zip E-Mail Order Date Phone Day Night FAX

Quantity	Item	Price	Total
BG-78 Calculator Bryan Gamble © Copyright 2001. All Rights Reserved. Total Sales Less: (5% NRA/SASS discount) Out of State=0% Colorado=3% La Plata Cnty=5% Plus Sales Tax Total Plus Shipping (see below) Subtotal Less: Deposit (50% down) Balance Due     Shipping Via US Post Office UPS Ground "Other" explain in notes USA Shipping: if Total = $0.00-99.00 = cost $7.50 $100.00-199.00 = cost $10.00 $200.00-299.00 = cost $12.50 $300.00-399.00 = cost $15.00 $400.00-499.00 = cost $17.50 $500.00 plus = cost $20.00 Payment Via Discover Mastercard Visa Check Money Order Cash, check, or money order number Card Holder Card # Exp Date 01 02 03 04 05 06 07 08 09 10 11 12 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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