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Please print form and mail or fax to: |
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Conley Precision Cartridge Co. 207 E. Oak Ave Como, MS 38619 Phone: 662-526-5886 Fax 662-526-9228 |
| Name: |
| Street Address: |
| City State & Zip: |
| Phone Days: Date: |
| Phone Nights: e-mail: |
| Is this your first Order?_____________ Residential or Commercial Delivery__________ |
| No. | Caliber or Description (Please Print) | Price /unit | Total Amount |
| S&H | |||
| MS. Res. add 7% Sales Tax | |||
| Total>>>> |
| REMEMBER: Shipping paid with five box orders. Less than five box orders add $20.00 shipping and handling. For complete shipping and conditions please visit our site www.cpcartridge.com or contact us. |
| Card Type: M/C VISA | Card Number: |
| Expiration Date: | CVV Number |
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When ordering with a credit card, Mailing Address MUST match statement of credit card. |