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Print this page, fill it out completely and mail to:
ShadeClothStore.com
801 E. Orchard
Mundelein, IL 60060
Please include either a check made payable to Shade Cloth Store, LLC or your credit card information.
| Item# | Description | Price | Qty | Total |
|---|---|---|---|---|
| Sales Tax 8% Illinois Res. Only | ||||
| Shipping & Handling | ||||
| Total | ||||
Keycode: ____________
Name: ____________________________________
Address: ____________________________________
City:____________________________________
State:__________________
Zip: __________________
Phone Number:(____________)_______________________
Email Address: ____________________________________
_____ Visa
_____ MasterCard
_____ Discover
_____ Check
Credit Card Number ________________________________________________________________
Expiration Date ______________
CVV2 # __________________
How would you like to be contacted? _________________________________________