Print-able Order form

PRINT THIS ORDER FORM AND MAIL WITH PAYMENT INFORMATION TO: Walnut Ridge Primitives 10525 Yale Bridge Rd. Rockton, IL United States 61072 Phone #: Fax #: Email: WalnutRidge1@aol.com
Circle Payment Method: Check Money Order
Print Name:
Address:	Email:
City:
State & Zip:
Telephone:	Signature:_____________________

Item Name and Description	Quantity	Price














Subtotal:
Shipping and Handling:
IL residents must add 7.25% sales tax-
MAKE CHECKS PAYABLE TO: Chris Mathis	Total :

Thank you for shopping at Walnut Ridge Primitives.